Recurrent Perforation of a Gastric Ulcer with Retroperitoneal Extravasation: Report of a Case

消化性潰瘍併穿孔是消化性潰瘍之一重要併發症。胃潰瘍併胃後壁穿孔則是少見且不易診斷，其致死率亦高。我們報告－病例：病患為八十歲男性因腹部疼痛及解黑便求治。此病患在三年前有胃潰瘍併胃後壁穿孔病史。此次於腹部理學檢查時可見腹壁僵直及腹膜炎徵像。在站立胸部X光片檢查時於橫隔膜下方並與任何可見之游離空氣，所以施行上消化道內視鏡檢查。以胃腸道內視鏡檢查時於胃後壁可見一邊緣明顯的穿孔。進一步以腹部電腦斷層掃瞄發現腸繫膜脂肪混濁及腸繫膜血管周圍有不規則的腸氣及自由氣體表現。經緊急手術時發現胃潰瘍併胃後壁穿孔及後腹膜腔滲出並修補之。當病患有明顯消化性潰瘍併穿孔的臨床表徵時，即使一開始的影像學檢查並不能証實，進一步的腹部電腦斷層掃瞄仍是必須的。

關鍵字

胃後壁穿孔之消化性潰瘍；胃潰瘍；後腹膜腔滲出

並列摘要

Perforation of a peptic ulcer (PPU) is one of the major complications of peptic ulcer disease (PUD). Posterior PPU is rare, the diagnosis is difficult, and the mortality is high. We report an 80-year-old man admitted with abdominal pain and melena who had a posterior perforation of a gastric ulcer 3 years previously. On abdominal examination, he had muscle guarding and peritoneal signs. There was no free air under the diaphragm on an upright chest x-ray. Esophagogastroduodenoscopy (EGD) showed an ulcer on the posterior wall of the antrum containing a hole with a sharp margin. Abdominal computed tomography (CT) showed a dirty appearance of the mesenteric fat and a bizarre bowel air pattern around the mesenteric vessels. An emergency operation was performed, and the gastric ulcer that had perforated retroperitoneally was repaired. If initial plain x-rays are unrevealing in a patient with significant symptoms and signs that may be attributable to PPU, further examination by abdominal CT is indicated.

並列關鍵字

posterior perforated peptic ulcer ； gastric ulcer ； retroperitoneal extravasation

國際替代計量

Recurrent Perforation of a Gastric Ulcer with Retroperitoneal Extravasation: Report of a Case

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