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Posttransplant lymphoproliferative disorder (PTLD) is documented as one of the serious complications leading to mortality particularly in organ transplant recipients receiving immunosuppressive therapy. Extant literature confirms beyond doubt that the most common site of involvement of PTLD is lymph nodes, and rarely involved is the gastrointestinal tract. It is a well-known fact that Epstein-Barr virus (EBV) is a risk factor for PTLD development. In this study, we report a case of PTLD presented as small bowel perforation without EBV infection after long-term immunosuppressive therapy in a renal transplant recipient.

Background Ileostomy reversal is frequently performed in abdominal surgery. Postoperative complications after ileostomy reversal are encountered in around 20% of patients. Data regarding risk factors for reoperation after ileostomy closure are scarce. The purpose of this prospective trial was to determine risk factors for operative revision after ileostomy closure. Materials and methods This is an additional post hoc analysis of a two center prospective trial. After enrollment, patient characteristics and intraoperative details were analyzed. Patients were followed up at one postoperative visit before discharge and at a three months postoperative visit by standardized questionnaire. All reoperations occurring in the three months period after surgery were analyzed, and immediate reoperations which were directly related to the ileostomy reversal were analyzed separately. Results 118 patients with elective ileostomy reversal were included in the trial. 12 out of 106 patients (11.3%) underwent any reoperation within three months after surgery (Clavien-Dindo grade IIIb). On multivariate analysis, anemia was associated with any reoperation p = 0.004; OR 6.93 (95% CI 1.37–30.07). Six out of 114 patients (5.3%) required an immediate reoperation (small bowel perforation, anastomotic leakage, postoperative ileus, deep wound infection) due to surgical complications directly related to the ileostomy reversal. Higher body mass index and anemia were associated with immediate reoperations (BMI: p = 0.038; OR 0.73 (95% CI 0.55–0.98); anemia: p = 0.001; OR 25.50 (95% CI 3.87–168.21). Conclusion Surgical complications after ileostomy reversal occurred to a substantial extent. Rate of reoperations was associated with anemia and high body mass index. Optimizing patients in terms of preoperative hemoglobin and BMI may reduce surgical complications after ileostomy closure.

Small bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement. When seen, it most commonly affects the stomach or colon. We describe a case and image findings of an 8-year-old female who presented with sepsis and erosion of the VP shunt into the small bowel. The imaging findings were confirmed surgically. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment.

Small bowel perforation is a life threatening event. Clinically, it presents catastrophically as an acute abdomen and rapidly progressive multi organ failure in the absence of early diagnosis and management. In neonates and children, erythema of and around the umbilical region has been described as an ominous sign, that point toward direful intra- abdominal pathology. Here we present a similar sign (red umbilicus) in an adult cirrhotic, in whom early assumption led to swift diagnosis of intestinal perforation.

Denture ingestion with bowel perforation is rare. We report a case, with literature review, where successful emergency surgery was performed.

Small bowel metastasis from primary lung cancer is rare. Once occurs, the metastasis may cause life-threatening complications, such as bowel perforation, obstruction and bleeding. We reported an 83-year old man who presented with small bowel perforation secondary to metastatic lung cancer after being treated with erlotinib for 2 weeks. We propose that the use of erlotinib may be associated with the small bowel perforation and precautions should be taken by clinicians in initiating erlotinib for primary lung cancer when there is bowel metastasis.

Background: Pneumoscrotum is a rare disease entity in which gas is present in the scrotum. It has been described after diagnostic and therapeutic procedures, as well as with disease states. The entity itself is a benign condition, but is associated with both incidental and life-threatening conditions. Objectives: We discuss the pathophysiology and associated conditions of pneumoscrotum. Case Report: We report a case of pneumoscrotum after jejunum perforation. Conclusion: Even though pneumoscrotum is a benign, rare condition, its mere presence should signal the possibility of a severe, life-threatening disease process within the peritoneum or retroperitoneum.

Nontraumatic perforation of small intestine (NTPSI) is a fairly common cause of peritonitis in developing world requiring early surgical intervention. Various etiological factors have been proposed for the cause of small bowel perforation. This retrospective study was conceded with an aim to determine the prevalence patterns of the different etiologies of NTPSI.A total of 164 patients were included in the study who had segments of small intestine removed for perforation during emergency procedures. Preoperative definitive diagnoses were not known in these cases. On gross examination, most of the small intestine perforations, n = 110 (67%), were found in the terminal ileum. On microscopy, the most frequent category was that of ulcers of nonspecific etiology, n = 61 (37.2%), which showed general features like inflammatory granulation tissue, serositis, and foreign body giant cell reaction.In cases where a definite opinion could be established, infection was the commonest cause, n = 71 (43.3%), wherein tuberculosis (49, 29.9%) and typhoid (22, 13.4%) constituted the greatest number of cases. There were two cases of lymphoma and one case of metastatic adenocarcinoma involving the small intestine. Thus, histopathological examination of operated specimen is a useful guide for the surgeon to decide further management of the patient especially in the case of infections.

症例は6歳，男児．Henoch-Schonlein紫斑病（HSP）に対し，前医にてステロイドや第XIII因子，ウリナスタチンの投与，ステロイドパルス療法などの対処療法を行ったが，紫斑，腹痛，下血は徐々に増悪した．腎機能障害も出現し，第16病日当院小児科紹介入院となった．再度ステロイドパルス療法，ステロイド投与を行い，症状・検査データーともに一時改善に向かったが，第24病日腹痛再燃，翌日腹部筋性防御が出現，消化管穿孔の診断で同日緊急手術を施行した．回腸に約50cmにわたる壊死腸管を認め，穿孔が多発しており，同部を切除し吻合した．病理組織学検査にて，HSPに特有な血栓や血管炎の所見は乏しく，またHE染色で巨細胞封入体，免疫組織化学染色でCMV陽性像を認めた．血液検査にてCMVアンチゲネミア陽性，以上よりCMV腸炎の合併が証明され，穿孔の原因であると考えられた．早期のステロイド減量を心掛け，術後33日目退院となった．

Surgical therapy has become the most effective long-term treatment for morbid obesity [1]. Reported incidence rates of surgical leaks after bariatric surgery range from 0.1% to 6% [2–4]. Endoscopic placement of self-expandable stents (SESs) is a nonsurgical means of treating leaks. Migration of the stent is the most common complication of SES replacement [5]. Treatment of this complication includes either repositioning of the stent or waiting for it to pass through the rectum. We describe the first case of stent migration after a sleeve gastrectomy leak that resulted in small bowel perforation requiring a laparotomy. We present a review of the relevant literature.

Background: Small bowel perforation is one of the most common abdominal surgical emergencies encountered in present study region. Late presentation makes them a diagnostic and treatment dilemma. The aim of present study was to determine the age, sex, incidence, etiological factors, clinical features and various surgical procedures for small bowel perforations and its complications in the setup.Methods: Present study is a prospective observational study of 100 cases, conducted in a single teaching institute from October 2015 to December 2016. Various data such as presentation by the patient, age and sex incidence, etiologies, pathological features, morbidity and mortality associated with the causation and management were evaluated, tabulated and assessed. By analyzing the data, common etiologies of small bowel perforation, the most appropriate modality of investigation, treatment, and complications associated with different methods of management and possible ways to prevent them were studied.Results: Among all small bowel perforation, duodenal perforation (70%) was the commonest cause of small bowel perforation followed by ileal (23%) and jejunal (7%) perforations. The most common causes of ileal perforation was typhoid (47.8%) followed by tuberculosis (13%) and traumatic (13%). Overall mortality in small bowel perforation was 15%, with ileal perforation (39%) showing higher mortality rate than duodenal perforation (8.5%). Wound infection, toxaemia, uraemia, hypotension, and respiratory complications were common complications, more commonly noted in cases of ileal perforation.Conclusions: The study showed that effective pre-operative management with adequate fluid resuscitation, immediate operative intervention and good post-operative care led to better outcomes in these cases. Hence timely diagnosis and prompt management is the gold standard for favourable outcome in patients with small bowel perforation.

症例は47歳，男性．糖尿病，慢性腎不全による透析歴があり，今回は肺化膿症のため当院内科入院中であった．腹痛・嘔吐の精査で腹腔内膿瘍による小腸イレウスと診断し，緊急手術を施行した．術中所見は回盲部・ダグラス窩に膿瘍を認め，回腸が強固に癒着していた．回腸にわずかな穿孔部を認め，小腸穿孔による腹腔内膿瘍と考えられた．病理組織検査では回腸粘膜上に横川吸虫を認め，周囲には広範な浅い潰瘍と高度の好酸球浸潤が見られた．以上の所見から横川吸虫症による腸炎が穿孔の主因と考えられた．横川吸虫症の多くは無症状であるが，寄生数が増えると腹痛・下痢などの症状を呈するとされる．しかし，われわれの調べ得た範囲では，本例のように小腸穿孔を発症した報告は本邦初であり，文献的考察を加えて報告する．

症例は59歳，男性．右上葉腫瘤とNSEおよびCEA高値にて気管支鏡生検を行い，肺小細胞癌（T4N3M1）と診断した．cisplatin+etoposideを4コース施行後の効果判定はPDで，5コース目に胸部放射線照射を併用した．5コース終了後の効果判定はPDであり，以後，2nd lineの化学療法を予定していたが，経過中に腹痛を訴え，当科紹介された．腹部に筋性防御と反跳痛を認め，血液検査にて炎症反応は高値であった．腹部CT検査にて小腸の壁肥厚と周囲のfree airを認めたため，消化管穿孔と診断し，緊急手術を施行した．手術所見は，腹腔内に膿性腹水を認め，回盲部から約35cm口側に小腸腫瘤および同部の穿孔を認め，小腸部分切除を施行した．切除標本は，粘膜面に潰瘍を認め，漿膜面に腫瘤とその中心に穿孔を認めた．組織学的には粘膜面に深い潰瘍を形成しており，裸核状の比較的小型の異型細胞が瀰慢性に増殖していた．免疫染色では，synaptophysin(+)，CD56(+)であり，肺癌の小腸転移と診断した．術後経過は問題なく転科とした．

症例は66歳，女性．平成20年10月25日発熱と腰痛を主訴に受診．CT検査にて第3腰椎に腫瘤性病変を認めたため生検施行．病理組織検査にて悪性リンパ腫（diffuse large B-cell lymphoma）と診断された．11月5日THP-COP療法開始．12月17日CT検査にて腫瘍の縮小を認めたため3クール目開始．12月25日腹痛出現．CT検査にて消化管穿孔と診断され緊急開腹術施行．空腸に穿孔部を認め，穿孔部の小腸は後腹膜に強固に癒着していた．小腸部分切除術を施行した．病理組織所見では穿孔部の腸壁は壊死し周囲には好中球・慢性炎症細胞浸潤を伴う肉芽組織を認めた．周囲の漿膜下の動脈・静脈には器質化血栓による血管内腔の狭窄が見られ，血管障害による血流障害が穿孔の原因と考えられた．

The authors report a case of fatal peritonitis due to small bowel perforation in a 21-month-old female child. Necropsy excluded natural disease and a thorough Coronial investigation concluded that an accidental fall onto a "doorstop" caused the bowel injury. The investigative findings are presented; the discussion address issues of diagnosis and causation/mechanism of injury.

透析患者に発症した特発性小腸穿孔の1例を経験したので報告する．症例は64歳，女性．5日前から持続する腹痛を主訴に来院した．既往歴にネフローゼ症候群，慢性腎不全，全身性エリテマトーデス（systemic lupus erythematosus:以下SLEと略記）がある．腹部CT検査で腹腔内遊離ガス像と多量の腹水を認めたため，消化管穿孔による腹膜炎の診断で緊急手術を施行した．Treitz靱帯より200cm肛側の小腸に約5mm大の穿孔が認められ，小腸部分切除術を行った．病理組織学的所見では穿孔部で粘膜，筋層，漿膜が完全に断裂していたが，慢性炎症所見は認めなかった．穿孔の原因を特定する所見がなく特発性小腸穿孔と診断した．術後，縫合不全を合併し再手術を行ったが，その後軽快し初回手術後73日目に退院した．

Perforation of the small bowel due to foreign body ingestion is a rare instance that occurs in less than 1% of all ingestions. Although rare, ingestion of blister pill packaging is becoming more recognised as a causative agent for intestinal perforation, but is very rarely reported to cause intestinal obstruction. This is a report of a 66-year-old woman who presented with intestinal obstruction and underwent laparotomy, revealing small bowel perforation by a piece of blister pill pack foil. The patient was incognisant of the ingestion.

Objective: The aim of this study was to report our management and outcomes of patients who underwent surgery with the diagnosis of non-traumatic small bowel perforation.Methods: The records of 30 patients who underwent surgery for non-traumatic small bowel perforation between 2005 and 2013 were examined. Age, gender, complaints, duration of symptoms, comorbid disease(s), perforation location, length of stay in hospital, etiology, surgical treatment, morbidity, and mortality data were recorded. Patients were divided into two groups, survivors and non-survivors, and their features were compared.Results: The mean age of the patients was 51.3±19.9 years. Signs of peritoneal irritation were present in 22(73.3%) patients. In surgical exploration, generalized purulent peritonitis was observed in 14(46.6%) patients, while localized peritonitis was observed in the others. Bowel resection was performed in 27(90%) patients, while primary suture was performed in only 3(10%) patients. A diverting ileostomy was performed in 18(60%) patients. Mortality was observed in 9 (30%) patients. Duration of the symptoms and multiple perforations were significantly higher in non-survivors.Conclusion: A delay in diagnosis and presence of multiple perforations are the most important causes of mortality. Every effort should be made to avoid delay in diagnosis; however, once the diagnosis is delayed, especially in patients with multiple perforations, extensive surgery such as bowel resection and ileostomy should not be avoided. J Clin Exp Invest 2015; 6 (2): 130-134Key words: Non-Traumatic, small bowel perforation, diagnosis, management, Amaç: Bu çalışmanın amacı, travmatik olmayan ince barsak perforasyonu nedeniyle ameliyat edilen hasta yönetimimizi ve sonuçlarını sunmaktır.Yöntemler: Kliniğimizde 2005 ve 2013 arasında travmatik olmayan ince bağırsak perforasyonu nedeniyle ameliyat edilen 30 hastanın kayıtları incelendi. Hastalara ait yaş, cinsiyet, şikayetler, belirtilerin süresi, eşlik eden hastalık(lar), perforasyon yeri, hastanede kalış süresi, etyoloji, cerrahi tedavi, morbidite ve mortalite verileri kaydedildi. Hastalar yaşayanlar ve ölenler olmak üzere iki gruba ayrıldı ve grupların çeşitli özellikleri karşılaştırıldı. Bulgular: Hastaların yaş ortalaması 51,3±19,9 yıl idi. Periton irritasyonu bulguları 22 (% 73,3) hastada vardı. Eksplorasyonda 14 (% 46,6) hastada yaygın pürülan peritonit gözlenirken, diğerlerinde lokalize peritonit mevcuttu. Primer sütürasyon sadece 3(%10) hastaya uygulanırken, barsak rezeksiyonu 27 (%90) hastaya uygulandı. Saptırıcı ileostomi 18 (%60) hastaya uygulandı. Mortalite 9 (%30) hastada gözlendi. Semptom süresi ve çoklu perforasyon varlığı mortalite gelişen hastalarda anlamlı derecede yüksek bulundu.Sonuç: Tanıda gecikme ve çoklu perforasyon varlığı mortalitenin en önemli nedenleridir. Tanıda gecikmeyi önlemek için her türlü çaba harcanmalıdır; ancak, eğer tanı gecikmişse, özellikle çoklu perforasyonu olan hastalarda bağırsak rezeksiyonu ve/veya ileostomi gibi geniş cerrahi prosedürlerden kaçınılmamalıdır

Abdominal wall necrotising fasciitis secondary to fish bone ingestion is extremely rare. We present a case of ingested fish bone complicated with self-sealing small bowel perforation and abdominal wall necrotising fasciitis. Following principles of necrotising fasciitis, a high index of suspicion led to early diagnosis and early treatment. The patient enjoyed a good recovery.

Aydin, Oktay/0000-0001-5728-0128; Bayrak, Vedat/0000-0002-6111-3573; yilmaz, ozkan/0000-0001-7320-0722 WOS: 000215566400164 PubMed: 26273488 Endoscopic biliary stents have been recently applied with increasing frequency as a palliative and curable method in several benign and malignant diseases. As a reminder, although most of the migrated stents pass through the intestinal tract without symptoms, a small portion can lead to complications. Herein, we present a case of intestinal perforation caused by a biliary stent in the hernia of a patient with a rarely encountered incarcerated incisional hernia.

Chronic low back pain is one of the leading chief complaints affecting adults in the United States. As a result, this increases the percentage of patients that will eventually undergo surgical intervention to alleviate debilitating, chronic symptoms. A 37-year-old woman presented ten hours postoperatively after a lumbar laminectomy with an acute abdomen due to the extraordinarily rare complication of small bowel injury secondary to deep surgical penetration.

Turk J Emerg Med 2015 doi: 10.5505/1304.7361.2015.59002 Submitted: September 10, 2014 Accepted: October 13, 2014 Published online: February 17, 2015 Correspondence: Huseyin PulaT, M.D. Suleyman Demirel universitesi Tip Fakultesi, Cerrahi Onkoloji Bilim Dali, 32000 Isparta, Turkey. e-mail: drhpulat@hotmail.com 1Department of Surgical Oncology, Suleyman Demirel University Faculty of Medicine, Isparta; 2Department of General Surgery, Suleyman Demirel University Faculty of Medicine, Isparta; 3Department of Radiology, Suleyman Demirel University Faculty of Medicine, Isparta, all in Turkey Huseyin Pulat,1 Oktay KaraKOse,1 Mehmet Fatih Benzin,2 seyma Benzin,3 recep Cetin1

Resume Objectif. – Evaluer la morbimortalite associee a l'excision–suture et a la resection–anastomose dans le traitement chirurgical des perforations non traumatiques uniques du grele (PNTUG). Methode. – De juillet 2002 a juin 2003, nous avons procede a une etude randomisee en simple insu comparant l'excision–suture simple a la resection–anastomose pour PNTUG. Resultats. – Sur les 125 patients inclus, 112 ont ete operes par des chirurgiens en formation (89,6 %). La perforation siegeait sur le bord antimesenterique des dernieres anses ileales avec un diametre moyen de 0,8 cm (extremes 0,1 et 4 cm). Une excision–suture a ete pratiquee 66 fois (52 %) dont 5 fois par un chirurgien confirme et une resection–anastomose 59 fois (48 %) dont huit fois par un chirurgien confirme. Cinquante-six patients ont eu des suites simples (45,2 %). La morbidite a touche 68 patients (54,8 %). Six patients sont decedes de complications generales (4,8 %). La technique operatoire n'a pas influence la mortalite. Tous les patients decedes ont ete operes par des chirurgiens en formation, p = 0,25. Les complications etaient significativement plus frequentes apres resection–anastomoses (79,7 %) qu'apres excision–suture (32,3 %). La difference etait significative pour les suppurations parietales (p = 0,01), les fistules exteriorisees (p = 0,04), les chocs septiques (p = 0,05). Conclusion. – La mortalite n'etait pas influencee par la technique, les suites etaient significativement plus compliquees apres resection–anastomose (surtout pratiquee par des chirurgiens peu experimentes). Nous recommandons l'excision–suture pour la reparation des PNTUG.

維持透析患者にみられた特発性小腸穿孔の1例を経験したので報告する. 患者は1994年より閉塞性腎不全のため維持透析施行中の70歳女性で, 2004年2月5日腹痛が出現し, 翌日の透析時, 同症状がさらに増悪し, 筋性防御, Blumberg徴候が陽性となったため救急入院した. 腹部単純X線立位像および腹部CTにて横隔膜下に腹腔内遊離ガス像を認め, 消化管穿孔による汎発性腹膜炎と診断し緊急開腹術を施行した. 全身麻酔下に開腹すると, 空腸に約10mmの穿孔を認める以外, 腹腔内に異常が認められず, 穿孔部を含めて長さ5cmの空腸を切除し, 小腸端々吻合術を行った. 術後経過は順調で同年3月12日に軽快退院した. 切除部の病理組織では出血性壊死を伴った穿孔がみられたが, ほかに虚血性, 慢性炎症性, 悪性変化など認めなかった. 穿孔の原因を特定する所見が認められず特発性小腸穿孔と診断した. 維持透析患者の特発性小腸穿孔は文献的にまれであり, 重篤な合併症の予防のためには即刻の開腹術が必要であると考えられる.

患者は慢性関節リウマチで治療中の72歳の女性で, 食思不振のため入院中. 上腹部痛が出現し, 腹部CTにて, Free air像と著明な腹水がみられ, さらにショック状態を呈した. 消化管穿孔による汎発性腹膜炎と診断, 開腹手術を施行した. 上部空腸に穿孔を認め, 空腸部分切除術を施行した. 術後, 全身状態は徐々に悪化し, 第6病日に多臓器不全のため死亡した. 血清アミロイドA蛋白 (SAA) の著明な上昇と, 組織学的に切除小腸の粘膜筋板と血管平滑筋などにアミロイド沈着があった. 小腸憩室に穿孔を認め, 慢性関節リウマチに続発したアミロイドーシスの消化管穿孔と診断した. アミロイドーシスによる消化管穿孔はまれであるが, 慢性関節リウマチの増加に伴い, 今後増加することが予想される. 慢性関節リウマチの既往のある急性腹症では, 消化管アミロイドーシスの鑑別を念頭におく必要があると考えられた.

L'ileus biliaire est une complication rare de la lithiase biliaire; il est caracterise par la triade radiologique, syndrome occlusif, aerobilie et localisation ectopique d'un calcul dans le tube digestif. La cause est generalement une fistule cholecysto-duodenale. L'enclavement de calcul au niveau d'une anse qui est generalement la derniere anse ileale peut se compliquer d'une perforation grelique. Nous rapportons le cas d'un patient de 72 ans, admis pour syndrome subocclusif remontant a une semaine, chez qui l'examen clinique trouve un patient febrile a 37,8 °C avec une defense peri-ombilicale et epigastrique avec au bilan biologique une CRP a 320 et GB=8000 elt/mm3 et une insuffisance renale d'allure fonctionnelle. Un ASP a montre des niveaux hydro aeriques geliques et une TDM abdominale - a mis en evidence une aerobilie avec une fistule cholecysto-duodenale associee a pneumoperitoine. L'exploration chirurgicale confirme la presence de la fistule cholecysto-duodenale et objective la presence de deux calcules cholesteroliques au niveau de la lumiere intestinale avec une perforation grelique a 1m20 de l'angle de treitz. Le geste chirurgicale a consiste en une resection d'environ 10 cm de grele emportant la perforation avec extraction de deux gros calcules de 4 et 3 cm de grand axe et transformation des deux bouts greliques en une stomie a la Bouillie-Wolkman sur le flanc gauche et a un lavage et drainage et nous avons decide de ne pas liberer la fistule cholecysto-duodenale et de la traiter ulterieurement. Les suites post operatoire immediates ont ete simples.

尿管結石に対してESWLを施行した後, ESWLが原因で小腸穿孔による急性汎発性腹膜炎が発生した症例を経験した.症例は,左腹壁腫瘍切除術(開腹)の既往がある64歳,男性.左腎部分サンゴ状結石に対して9回目のESWLを腹臥位で行った3時間後から腹痛をきたした.翌日になっても症状は軽快せず来院した.腹部レントゲン・腹部CTにてfree airと腹水を認めたため消化管穿孔と診断し,緊急手術を施行した. ESWL施行部直下に癒着していた小腸に小孔を認め模状切除・縫合閉鎖術を行った.術後経過は良好であった. ESWLによる腸管穿孔の報告例は海外も含めて14例と極めて稀な合併症であるが,開腹歴があり腹臥位でESWLを行った症例では注意を要すると考えられた.

Summary Bowel perforation caused by a foreign body is an uncommon etiology of acute abdomen. An accurate diagnosis of the level and cause of the perforation is essential for therapeutic planning, but it is usually challenging. This report presents the case of a 66-year-old man who underwent a diagnostic laparoscopy for suspicion of hollow viscus perforation. We used the underwater intestinal milking method to detect the perforation caused by fish bone, which was intracorporeally repaired using interrupted sutures. Because of the lack of tactile sensation, a laparoscopic diagnosis of acute abdomen is completely dependent on visual assessment. Therefore, making the correct decision requires expertise and sufficient skill in laparoscopic surgery. The experience reported herein is feasible for the diagnosis and management of small bowel perforation caused by a foreign body.

消化管穿孔の中で非外傷性小腸穿孔は比較的稀で,その原因も様々である.今回,われわれは稀な特発性小腸穿孔の1例を経験したので報告する.症例は84歳,男性. 82歳時に胆嚢癌にて膵頭十二指腸切除術を施行された.腹部全体の圧痛・腹膜刺激症状を認め,胸部・腹部X線検査では腹腔内遊離ガス像,イレウス像を認めなかったが,腹部CTで腹腔内遊離ガス像を認めたため,汎発性腹膜炎と診断し緊急開腹術を施行した. Bauhin弁から約65cm口側に回腸穿孔を認め,回腸部分切除術を施行した.転移や再発を認めず,腹腔内の癒着やイレウスを認めなかった.組織学的にも粘膜,筋層,漿膜は断裂し,粘膜の漿膜側へのslidingを認めず,悪性所見や慢性の炎症所見を認めなかった.穿孔の原因を特定する所見はなく,特発性小腸穿孔と診断した.術後の経過は良好であったが,術後76日目に他病死した.