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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

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)