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Article
February 1968

Perforated Jejunal Ulcer and the Zollinger-Ellison Syndrome

Author Affiliations

West Roxbury, Mass
From the Surgical Service, Veterans Administration Hospital, West Roxbury, Mass (Drs. Watson, Moseley, and Wheeler); and Harvard Medical School, Boston (Dr. Wheeler). Dr. Watson is presently at the Peter Bent Brigham Hospital, Boston; Dr. Moseley is presently a captain in the US Army Medical Corps, Walter Reed Army Hospital, Washington, DC.

Arch Surg. 1968;96(2):274-276. doi:10.1001/archsurg.1968.01330200112023
Abstract

PERFORATION of the jejunum is an uncommon disorder, rarely diagnosed preoperatively. The etiology is often unknown but usually is associated with advanced age, arteriosclerosis, or prolonged oral administration of chlorothiazide (thiazide [Canada]; Diuril [comparable US product]) and potassium therapy.1-8 Jejunal perforation has also been reported secondary to trauma,9 foreign body, jejunal diverticulitis,10 steroid therapy, collagen disease associated necrotizing arteriolitis,11,12 malignancy,13-15 and superior mesenteric arterial occlusion.16

This report documents an unusual case of jejunal perforation due to the Zollinger-Ellison syndrome. Although the diagnosis was not entertained preoperatively, it was suspected and confirmed intraoperatively, leading to definitive therapy and a gratifying clinical response.

Report of a Case  A 33-year-old white man (WRVAH-264522) was admitted with a six-month history of vague abdominal pain. His initial symptoms of postprandial pain relieved by milk and alkali led to the diagnosis of duodenal ulcer, confirmed on an upper gastrointestinal (GI)

References
1.
Alexander, H.C., and Schwartz, G.F.:  Nonspecific Jejunal Ulceration: In Search of an Etiology , Gastroenterology 50:224-230, 1966.
2.
Campbell, J.R., and Knapp, R.W.:  Small Bowel Ulceration Associated With Thiazide and Potassium Therapy: Review of 13 Cases , Ann Surg 163:291-296, 1966.Article
3.
Evert, J.A.; Black, B.M.; and Dockerty, M.B.:  Primary Nonspecific Ulcers of the Small Intestine , Surgery 23:185-200, 1948.
4.
Lindholmer, B.; Nyman, E.; and Raf, L.:  Nonspecific Stenosing Ulceration of Small Bowel: A Preliminary Report , Acta Chir Scand 128:310-311, 1964.
5.
Litwin, M.S., and Crane, C.:  Primary Nonpeptic Ulcer of the Jejunum , Ann Surg 151:594-599, 1960.Article
6.
Morgenstern, L.; Freilich, M.; and Panish, J.F.:  The Circumferential Small Bowel Ulcer: Clinical Aspects in 17 Patients , JAMA 191:637-640, 1965.Article
7.
Payan, H., and Blaustein, A.:  Potassium Chloride and Small Bowel Perforation , Gastroenterology 48:877-878, 1965.
8.
Teicher, I., et al:  The Clinical-Pathological Spectrum of Primary Ulcers of the Small Intestine , Surg Gynec Obstet 116:196-202, 1963.
9.
Markowitz, A.M.:  The Less Common Perforations of the Small Bowel , Ann Surg 152:240-257, 1960.Article
10.
Elliot, R.L.; Yelverton, R.; and Barnett, W.O.:  Jejunal Diverticulitis With Perforation and Peritonitis: Case Report , Amer Surg 31:499-502, 1965.
11.
Brown, C.H.; Scanlon, P.J.; and Haserick, J.R.:  Mesenteric Arteritis With Perforation of the Jejunum in a Patient With Systemic Lupus Erythematosus: Report of a Case , Cleveland Clin Quart 31:169-178, 1964.Article
12.
Finkbiner, R.B., and Decker, J.P.:  Ulceration and Perforation of the Intestine Due to Necrotizing Arteriolitis , New Eng J Med 268:14-18, 1963.Article
13.
Colcock, B.P., and Adamson, N.E., Jr.:  Adenocarcinoma of the Jejunum and Ileum , Surg Clin N Amer 39:737-744, 1959.
14.
Donald, J.W., and Donald, J.G.:  Adenocarcinoma of the Proximal Jejunum , Amer Surg 31:209-212, 1965.
15.
Higgins, P.M.; Lehman, G.; and Morton, H.S.:  Perforation of Jejunal and Ileal Neoplasms: A Survey of the Literature and Case Reports , Canad J Surg 6:338-347, 1963.
16.
Gillespie, G.:  Unusual Case of Multiple Spontaneous Perforations of Small Bowel , Brit Med J 5506:155-156, 1966.Article
17.
Zollinger, R.M., and Ellison, E.H.:  Primary Peptic Ulcerations of the Jejunum Associated With Islet Cell Tumors of the Pancreas , Ann Surg 142:709-728, 1955.Article
18.
Oberhelman, H.A., et al:  Ulcerogenic Tumors of the Duodenum , Ann Surg 153:214-227, 1961.Article
19.
Liu, D. H-Y.; Crastnopol, P.; and Phillips, W.:  Perforation of a Gastrojejunal Ulcer Into the Pericardium , Arch Surg 94:294-298, 1967.Article
20.
Ellison, E.H., and Wilson, S.D.:  The Zollinger-Ellison Syndrome: Reappraisal and Evaluation of 260 Registered Cases , Ann Surg 160:512-530, 1964.Article
21.
Wilson, S.D., and Ellison, E.H.:  Survival in Patients With the Zollinger-Ellison Syndrome Treated by Total Gastrectomy , Amer J Surg 111:787-791, 1966.Article
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