A case of perforated anastomotic ulcer, which is rare recently, was successfully treated by omental implantation.
A 40-year-old man, who had undergone a distal partial gastrectomy with Billroth II reconstruction for perforated duodenal ulcer at the age of 18, was seen at the hospital because of tenderness and muscular defense throughout the upper abdomen. The white blood cell count was 13, 190/mm³, CRP was 0.01mg/dl, and gastrin level was low. Chest and abdominal X-ray films revealed free air in the subphrenic space. An abdominal CT scan showed intraperitoneal free air around the remnant stomach and gastrojejunostomy. An emergency laparotomy was performed with a diagnosis of panperitonitis. During surgery, a perforated ulcer at the anastomotic site, which was reconstructed by antecolic Billroth II procedure and Braun anastomosis, was comfirmed and then peritoneal drainage and omental implantation were carried out. A proton pump inhibitor was given to the patient after the operation. The postoperative course was good and he was discharged on the 20th postoperative day. Omental implantation is useful for perforated anastomotic ulcer and is able to become one choice for emergency surgery. But this method is not a radical operation and there is a possibility of recurrence. It is important to follow the patient as long as possible keeping possible reoperation in mind.