生後３カ月時に多発性十二指腸穿孔を認めた超低出生体重児の１例

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  • A CASE OF MULTIPLE DUODENAL PERFORATIONS IN THE EARLY INFANCY

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Duodenal perforation in the early infancy is an uncommon condition. We present a case of multiple duodenal perforations in a premature boy born with an extremely low body weight. The premature boy was born at the gestational age of 26 weeks by emergency cesarean section resulting from pelivic presentation, amniorrhexis, and intrauterine infection. His birth weight was 764g. The Apgar at 1 min was 3 and, at 5 min, it decreased to 2. He required intermittent mandatory ventilation for about one month after birth. Ninety eight day after birth, he developed abdominal distension. A supine radiograph of the abdomen revealed massive pneumoperitoneum. Exploratory laparotomy disclosed two perforations at the first portion of the duodenum. Direct closure and peritoneal drainage were carried out. On the postoperative day 1, he had central urorrhagia due to hematencephalon. Oral feeding was started on the postoperative day 34, and the boy is now staying in the hospital. Hematological studies after surgery showed that Helicobactor pylori IgG antibody was positive and blood gastrins level was high. Culture for Helicobactor pyroli in stools was positive. Although the cause of the perforations in this case, remained undetermined, duodenal ulcer was the most likely cause. Growth after surgery has been normal without recurrence of duodenal ulcer.

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