Perforation Of Digestive Tract Research Articles

A bacteriological study of perforated duodenal ulcers

Peritoneal fluid sampling and bacteriological examination were performed in 63 patients with perforated duodenal ulcers, and the results compared with those in 175 patients with other perforations. Bacterial culture was positive in 100 per cent of the patients whose perforations occurred in the colon, whereas it was positive in only 44.4 per cent of those with duodenal perforations, being negative in many cases when the interval from perforation to surgery was short. A mixed contamination with both aerobes and anaerobes was usually found in the cases of lower digestive tract perforation, and the isolates from duodenal perforations were uniquely aerobes in most cases. It is suggested that bacteria play a minor role in the pathogenesis of early stage duodenal perforation, which supports the technique of primary closure without indwelling drainage tubes during early stage operations following sufficient peritoneal lavage. Moreover, if the stomach is empty at the time of perforation and the peritonitis is localized, even conservative therapy seems possible, provided it is begun shortly after the perforation.

A CASE OF COLONIC LIPOMA ACCOMPANIED WITH COLON CANCER

A case of colonic lipoma accompanied with colon cancer is presented. An 88-year-old female admitted to our hospital because of abdominal pain, nausea and melena. Chest X-ray demonstrated a free air under the diaphragma, but there was no abnormal findings in emergent gastroduodenoscopy. Laparatomy was performed under a diagnosis of perforation of the lower digestive tract, and a moderate amount of fecal ascites and a hard tumor palpable at the ascending colon were found, leading to the definite diagnosis of perforated peritonitis associated with ascending colon cancer. Therefore, right hemicolectomy and drainage were carried out. The surgical specimen revealed a pedunculated polyp (2.6×2.6×2.2cm) which was incarcerated to the carcinoma. Pathological features of the polyp were typical of submucosal lipoma There have been about 160 cases of colonic lipoma reported in Japan, and only 17 were associated with colorectal cancer. In the 17 cases, the aged (the mean age: 68.6 years) and females (male-to-female ratio: 3:14) were predominant, and the carcinomas preferred to occur in the right colon closing to the lipoma.