Primary Nonspecific Ulcer of the Small Intestine K. Hara 1 , Y. Suzuki 1 , M. Yamashiro 2 , H. Shimada 3 , T. Nakanmura 4 1First Department of Surgery, University of Tokyo Faculty of Medicine 2Department of Surgery, Yoikuin Hospital, Tokyo Municipal Home for the Aged 3Department of Pathology, Yoikuin Hospital, Tokyo Municipal Home for the Aged. 4First Department of Surgery, University of Gunma Faculty of Medicine pp.1599-1603
Published Date 1974/12/25
DOI https://doi.org/10.11477/mf.1403111720
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 A 76-year-old female was admitted because of abdominal pain, nausea and vomiting,For the past 8 months she had been suffering from episodes of vague abdominal pain. The days after admission the pain had become severe and peritonitis was suspected by physical examinations. Immediate laparotomy disclosed an area of concentric narrowing accompanied with a perforated ulcer at the mesenteric side of the proximal ileum. The mesentery in this region showed no abnormalities and no lymphadenopathy was present. A segmental resection of the ileum containing the lesion following entero-enterostomy were carried out. The post-operative course was completely uneventful.

 Gross examination of the surgical specimen revealed a small perforation surrounded by localized fibrosis which caused moderate stenosis of the intestinal lumen. In this area the mucosa contained a punched-out ulcer 0.8 by 0.5 centimeters in diameters. Microscopically the lesion was a subacute ulcer with perforation. Moderate fibrosis, inflammatory cell infiltration and congestion were observed in the submucosal space adjacent to the ulcer. Vascular changes such as thrombosis, embolism and arteriosclerosis were not discerned. The findings suggesting diseases caused by the foreignbody, parasite and fungus were not recognized. Specific inflammations such as tuberculosis. Crohn's disease and typhoid fever were also excluded histologically from the cause of the lesion.

 Since 1964, the reports of the nonspecific small bowel ulceration in foreign countries have been remarkably increased. The recently popularized treatment by potassium chloride or diuretics for cardiovascular or renal diseases have been suspected as one of the main reasons for such increased incidence of this lesion in foreign countries. On the contrary, ulcerations possibly caused by these drugs have rarely been reported in Japan.

 In this paper, we have reported a case of a perforated ulcer in the proximal ileum. The result of the clinical and laboratory examinations showed none of such causes mentioned above. So we diagnosed this case as primary nonspecific ulcer of the small bowel. Review of Japanese as well as foreign literature was done putting stress on the etiology of this peculiar lesion.

Copyright © 1974, Igaku-Shoin Ltd. All rights reserved.


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