内科側からみた穿孔性十二指腸潰瘍の臨床―頻度および内視鏡診断を中心に

Clinical Features of Perforated Duodenal Ulcer on the Part of Internal Medicine: lts frequency and endoscopic diagnosis

　従来，消化性潰瘍の穿孔は外科的救急疾患とされ，これまでの報告のほとんどが，本症の手術適応を中心に論じられてきた^{6)8)10)～12)15)16)}．近年，包括医療やprimary health careなどを基本とした救急医療体制が検討されるなかで，救急疾患に対する臨床各科の総合的な取り組みや緊密な連携が一層重視されている．このような視点に立ち，本稿では消化管穿孔のうち，最も高頻度を占める穿孔性十二指腸潰瘍について^6)8)11)，内科側からみた重要なポイントである本症の頻度や術前診断に関して若干の考察を述べる．

　Investigating the frequency of perforated duodenal ulcer during the past four years at our affiliate hospitals, it is estimated to be influenced by the medical background and surgical criteria of each hospital. At the hospitals in the region where these conditions may be constant, about one per cent of duodenal ulcers in a year is estimated to be perforated ones.

　For the preoperative diagnosis of perforated duodenal ulcer, the radiological confirmation of free gas in the peritoneal cavity is not so useful, but vigorous endoscopic examination is much more useful for gaining the detailed data including the detection of the site of perforation. We confirmed the perforated site in four patients with endoscopic examinations without any hazard or severe complications. Furthermore, in two out of four patients accompanied with manifest bleeding we detected the site of bleeding with endoscopy.