[Primary ulcerations of the small intestine]

The authors report a recent case of primary ulceration of the small intestine revealed by spontaneous perforation. This is a rare condition with a non specific semiology which only exceptionally permits diagnosis before complications occur. The latter are dominated by perforation, gastrointestinal hemorrhage and a sub-acute obstructive syndrome. The lesion, generally single, is found on the anti-mesenteric border of the jejunum or terminal ileum on a short only slightly inflammed segment and pathological examination does not reveal any specific process. Treatment is surgical. It confirms the diagnosis and enables a segmentary resection or simple suture to be carried out. The condition does not recur. A complete etiological investigation is required to exclude other causes of small intestinal ulceration before its "spontaneous" nature may be inferred. Infectious and vascular theories are most often proposed among the pathophysiological hypotheses. Far from being exclusive, these theories may interact and enable a coherent multi-factorial mechanism to be proposed as to the origin of the ulceration (regardless of its initial cause). Spontaneous ulcers are therefore included in a wider nosological classification ranging from stress ulcer to necrosing enteritis.