Abstract
Non-specific ulcer of the small intestine is a rare disease. Ulcer of the small intestine that develops in patients on chronic dialysis has not as yet been reported in Japan. We encountered a case of primary non-specific ulcer of the small intestine that resulted in perforation. This paper is a report of our findings.
The patient was a 68-year-old male. He had been on ambulatory dialysis three times a week, but was admitted to this hospital for close examination and treatment following complaint of right epigastric pain, and peritoneal irritation symptoms were noted in the region of pain. On echo and CT, the patient was diagnosed as having cholelithiasis and concomitant cholecystitis. Antibiotics were administered and the clinical course was observed. No improvement in the symptoms was recognized, so exploratory laparotomy was performed. Calculi were found in the gallbladder, but intense inflammatory findings were not observed. Solitary ulcer/perforation of the small intestine was present about 25cm from the terminal of the ileum. Partial resection of the small intestine and end-to-end anastomosis were performed. The perforated region was covered with normal intestinal tract and the peritoneal symptoms were localized, which presumably accounted for the difficulty in diagnosing this disease. Histopathological findings included intense inflammatory cell infiltration and fibrous hyperplasia, noted in the ulcerated region on HE staining. Congo red staining was performed to compare the ulcerated region with the nonulcerated region. Amyloid deposition in the vascular cndothelium was noted all over the intestinal tract. No relationship between ulceration and blood flow disturbance due to amyloidosis was found.
