内科的に治療した胃潰瘍穿孔の1例

A Case of Perforated Gastric Ulcer, Treated Nonoperatively

　欧米では消化性潰瘍の穿孔例を多数（1施設で256例，他施設の集計では1,102例も）内科的に治療して，よい成績を得たという報告がある．消化性潰瘍穿孔の内科的療法は欧米ではほぼ確立された治療法らしく，Bockusのtext bookにも数ページにわたって詳細に記載されている．これに反し本邦では，潰瘍の穿孔は手術の絶対的適応とされ，内科的に治療したという報告は，現在までのところ見当らない．ただ常岡教授はこのような治験例を持っておられるとのことである，著者らは特殊な事情のため胃潰瘍穿孔の1例を内科的に治療するという経験をしたので報告する．

　Many experiences of nonsurgical treatment of perforated ulcer were reported in western countries. In Japan many believe that perforated peptic ulcer should be operated on immediately. So there has been no report of its nonsurgical treatment in Japan.

　We experienced this method of treatmeut in a patient with perforation.

　A 32 years old woman was admitted in our hospital because of epigastric pain in March 1967, when x-ray examination showed a gastric ulcer. She was treated medically and discharged in April 1967. On April 20, 1971, she was admitted in another hospital because of severe attack of epigastric pain, and on April 24 she was transferred to our hospital because of continuing pain. On admission vital signs were normal, but boardlike rigidity and tenderness in epigastrium was noted. A scout film of the abdomen showed free air under the diaphragm on both sides, which confirmed the diagnosis of perforated gastric ulcer. We wanted immediate operation be performed, but no surgeon was available. We had to begin nonsurgical treatment; nothing was given by mouth and antibiotics and intravenous fluid were administered. The stomach was repeatedly evacuated by an inserted gastric tube. All went well. The pain subsided on the next day. On May 13 gastroscopy revealed a deep ulcer in the anterior wall of gastric body. On June 3, the ulcer almost healed endoscopically. She was discharged on June 13. No recurrence of gastric ulcer has been noted for about 3 years since then.