J.Jpn. Surg. Soc.. 62(5): 448-466, 1961
CLINICAL AND PATHOLOGICAL STUDY ON PERFORATED OR PENETRATING GASTRO-DUODENAL ULCER, WITH SPECIAL REFERENCE ON HISTOLOGICAL STUDY ON DEVELOPEMENT OF PERFORATION OR PENETRATION
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Second Surgical Department, Chiba University School of Medicine (Director : Prof . Komei NAKAYAMA) Tsutomu KIKUYAMA |
1. Incidence of perforated and penetrating ulcer were 2.1 and 22.5 per cent to 1681 cases the total number of ulcer patients during the same period. Total number of ulcers were 2291. Perforated ulcer were 38 with the ratio of 1.7%, while penetrating ulcers were 383 with the ratio of 16.7%.
2. Primary gastrectomy was performed on 31 cases out of 36 perforated ulcers with 4 death (mortality 11.1%). However, no patient was died after 1950 because of active emergency primary gastrectomy. Radical operation was performed on 374 cases out of 378 penetrating ulcers with 7 death (mortality rate 1.8%). After 1950 radical operation was done on all patients with mortality of 0.6%.
3. Granulation tissues of base of ulcers present different dynamic alterations in different seasons. These alterations have some relations with ulcer-pain or gastric haemorrhage. However, gastric acidity does not show any specific relationship.
4. Perforation or penetration may happen on any stage exclusive of the third stage of chronic ulcer. Most frequently there were observed at the first stage of chronic ulcer. However, these stages have no relationship with size, depth, shape, number, symmetry, of ulcer or duration of clinical symptoms.
5. The author has the following opinion on mechanism of perforation of ulcer. The main cause of perforation is due to the character of ulcer. There are two major factors namely development of ulcer at the deeper zone and periodical repeat of deeper demarcating inflammation in the base of chronic ulcer. In addition there are no histological difference between perforated and penetrating ulcer. Anatomical condition of the site of ulcer make these two different conditions.
(Author's abstract)
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