再生不良性貧血に合併した十二指腸潰瘍穿孔の1例

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  • A CASE OF PERFORATION OF DUODENAL ULCER ASSOCIATED WITH APLASTIC ANEMIA

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This paper describes a case of perforation of duodenal ulcer associated with aplastic anenia. A 23-year-old woman wh had been treated with steroid in a diagnosis of aplastic anemia at another hospital, was admitted to the hospital because of a severe epigastric pain. Physical examination disclosed marked tenderness over the entire abdomen, especialy in the right upper quadrant. Laboratory studies showed pancytopenia as follows: white blood cell count was 2, 900/mm3, red blood cell count was 135×104/mm3 and platelet count was 2.3×104/mm3. Abdominal plain X-ray films showed no free gas. Abdominal ultrasonography and computed tomography revealed no fluid collection. However, perforation of peptic ulcer was suspected because of the history of receiving steroid therapy and physical findings. Emergency laparotomy was carried out after transfusion of red blood cells and platelets. At operation, perforation of duodenal ulcer was observed at the anterior wall of the 1st portion of the duodenum, and it was closed by suture and covered with greater omentum. Postoperatively, 26 units of platelets transfusion and granulocyte colony stimulating factor (G-CSF) provided appreciable remission of white blood cell and platelet counts. The postoperative course was uneventful. It is though that platelets transfusion and administration of G-CSF are useful for the perioperative management in a patient with aplastic anemia.

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