老人の消化管穿孔

Perforation of the Digestive Tract in Old Age

　高年者のいろいろな疾患について検討する揚合に，疾患そのものの発生，経過などの特徴をみるものと，老人の身体状況と特定疾患との相関から特殊性をみるという2つのアプローチがある．老人に発生する穿孔もこの2つの点から検討することが必要と思われる．従来高年者の胃・十二指腸疾患の穿孔についての報告はかなりみられるが，消化管全体についての報告は少ない^1)～5)7)．筆者らは60歳以上の消化管を主とした穿孔症例について検討してみた．

　Gastrointestinal perforation in old age over sixty encounterecl for the past twelve years amounted to 42 cases, and its causes have been classified as follows: esophageal cancer, 3; gastric ulcer, 7; gastric cancer, 4; other gastric diseases, 2; duodenal ulcer, 5; ulcer of the small bowel, 2; ileus, 3; appendicitis, 6; cancer of the cecum, l; cancer of the colon. 4; ulcer of the rectum, 4; rectal trauma, 2 and rectum cancer, 1.

　Of 18 cases of perforation due to diseases of the stomach and duodenum, 8 were operated on, and 3 died during or immediately after surgical intervention. The death rate was 38 per cent. Of 21 cases of intestinal perforation, 15 Were operated on including 6 cases of appendicitis, and 5 succumbed during or immediately after operation. The death rate was 33 per cent. High mortality rate seen in these was due more to collapse of the patients before or during the operation than to accompanying other diseases.

　It is especially noteworthy that there have been as many as 19 non-operated cases in the present series. Our investigations on various causative factors such as symptoms, general conditions of the patients and concomitant other diseases, have shown that perforation of the digestive tract in old age is characterized by (1) vague complaints at times misleading on account of other accompanying diseases, resulting in delay in both the diagnosis and mapping out of general lines of management, (2) its tendency to occur during hospitalization due to other diseases, necessitating insuflicient examinations and resultant difficulty in diagnosis, and (3) underlying weakness or other accompanying diseases so serious that the patient cannot endure or survive the operative procedures. These features specific to old age presumably account for the high percentage of non-operated eases in the present investigation.