2017 Volume 53 Issue 5 Pages 1049-1053
An 11-year-old boy with Down syndrome was admitted to our hospital presenting with black stool and pale complexion. He underwent diamond-shaped anastomosis for congenital duodenal stenosis at another hospital at 1 day of age. A follow-up study was started at our hospital at 3 months of age, and a radical operation for Hirschsprung’s disease was performed at 7 months of age. The postoperative course was uneventful and there was no growth disturbance. At the time of admission, blood examination revealed a very low hemoglobin level (5.9 g/dl); thus, esophagogastroduodenoscopy (EGD) was performed and he was diagnosed as having hemorrhagic erosion of the anastomotic site. It was improved with the use of a proton pump inhibitor (PPI) within 2 months, and then PPI was discontinued. However, 6 months later, he was admitted to our hospital presenting with black stool and pale complexion again. Blood examination revealed a low hemoglobin level (8.2 g/dl). EGD showed an anastomotic ulcer with mild bleeding and a hemorrhagic erosion at the anal side. From the results of EGD and upper gastrointestinal tract X-ray, the anastomotic ulcer was suggested to be attributed to chronic stimulation by remaining food residues, gastric acid and bile. Additional treatments, such as gastrointestinal agonist drugs, dietary instruction and appropriate position, were fully effective against the anastomotic ulcer. Fifteen months later, there was no recurrence. It is important to remember that postoperative anastomotic ulcer could develop long after surgery, even if there is no anastomotic stenosis.
