A CASE REPORT OF PERFORATIVE PERITONITIS OF POSTOPERATIVE STRESS ULCER TREATED WITH FIBRIN GLUE INJECTED VIA AN ENDOSCOPE

We report a case of perforative peritonitis due to postoperative stress ulcer, which was successfully treated with endoscopical injection of fibrin glue. A 47-year-old man was diagnosed as carcinoma of the body of the pancreas and underwent a subtotal distal pancreatectomy. On the 9th postoperative day, he underwent abdominal cavity drainage because he developed peritonitis caused by the leakage of stump of residual pancreas. Postoperative upper gastrointestinal series revealed that the origin of peritonitis had been a perforation of stress ulcer. Conservative therapy failed to cure the perforation completely and intraabdominal abscess with high value of serum endotoxin persisted. So fibrin glue was injected to the ulcer via the gastrofiberscope using a catheter. The perforation was successfully closed by this intervention. He was discharged from the hospital. We conclud that the local use of fibrin glue via the endoscope is effective for the treatment of resistant ulcer.