PNEUMOPERITONEUM FOLLOWING USE OF THE FLEXIBLE GASTROSCOPE

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Abstract
A white [male], aged 77, suffering with a mild senile psychosis, hypochromic anemia, and atrophic gastritis with achlorhydria, was subjected to a gastroscopic examination with the flexible Wolf-Schindler gastroscope equipped with a rubber finger tip. The examination was carried out after a preliminary 12-hr. fast and was preceded by a hypodermic inj. of morphine sulfate gr. i and atropine sulfate gr. 1/150. The patient co-operated unusually well, and the examination was not remarkable except for the presence of characteristic changes of atrophic gastritis and a polyp-like artifact produced by the end of the instrument. 2 hrs. later the patient was permitted to partake of the regular hospital diet and was allowed up. 4 days after the gastroscopic examination free air was discovered under the diaphragm on routine radiological examination. At this time physical examination of the abdomen was essentially negative. The patient had had no abdominal pain, fever, or leukocytosis. The stomach was presumably perforated at the time of the examination as an X-ray of the chest done prior to gastro-scopy showed no free air in the peritoneal cavity. Of much interest was the absence of any abdominal pain or signs of peritonitis and the occurrence of spontaneous recovery. This case experience indicates that traumatic perforation of the stomach under the conditions of a gastroscopic examination may be symptomless and may be discovered only accidentally.

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