11/465. Massive tracheal necrosis due to compression by an innominate artery aneurysm associated with a grade IV Chagasic megaesophagus and chronic duodenal ulcer. A 49-year-old man suffered necrosis of the cephalad tracheal segment due to compression by an innominate artery aneurysm. A peritracheal abscess, a grade IV chagasic megaesophagus, and a duodenal ulcer were also present. The patient underwent a three-stage surgical treatment, and 7 years later he is doing well, and breathing and eating normally. ( info) |
12/465. A case of abscess caused by a penetrating duodenal ulcer. A case of abscess caused by a penetrating duodenal ulcer in a 34 year-old female patient is presented. She had a past history of duodenal ulcer and presented with a low grade fever which had persisted for 1 month. Abdominal ultrasound confirmed a hypoechoic mass and computed tomography revealed a low density area in the posterior side of the hepatoduodenal ligament. The common bile duct and portal vein were compressed. Mild peripheral enhancement was detected. laparotomy was performed and an abscess in the posterior side of the hepatoduodenal ligament was confirmed. The abscess was firmly adhered to the lesser curvature side of the bulbus and a penetrating duodenal ulcer scar was noted. In conclusion, this report describes a rare event where penetrating duodenal ulcer formed an abscess with only mild complaints. ( info) |
13/465. Unusual gastrointestinal features in a child with pernicious anemia. Pernicious anemia in childhood is a rare disease. The radiologic demonstration of gastric mucosal atrophy led directly to this diagnosis in an 11-year-old girl. In addition, there was deformity of the pyloric antrum and superficial ulceration in the stomach and duodenum. endoscopy and biopsy confirmed these findings. ( info) |
| Tension pneumoperitoneum in an 81-year-old man resulted from the perforation of an ulcer on the posterior aspect of the first stage of the duodenum into the lesser sac. This condition, though rare, should be considered in the differential diagnosis of the massively distended abdomen. A number of different causes of this condition have been reported, most of which are associated with various diagnostic and therapeutic procedures. Treatment is early laparotomy. ( info) |
15/465. Relapse of duodenal ulcers after successful eradication of helicobacter pylori in gastric ulcer patients. Relapse of duodenal ulcers was observed endoscopically after helicobacter pylori eradication therapy for gastric ulcer patients in 2 of 32 successful cases. One patient, a 40-year-old woman, received dual therapy with lansoprazole 60mg and amoxicillin 1000mg for 2 weeks because of an intractable, easily-relapsing gastric ulcer accompanied by duodenal ulcer scars that had not relapsed for 5 years. The H. pylori status was assessed by a rapid urease test, light microscopy, culture, and anti-H. pylori antibody. At 24 months after the cure of H. pylori she had upper abdominal pain and showed relapse not of the gastric ulcer but of the duodenal ulcer. The H. pylori status remained negative. The other patient, a 44-year-old man, showed an active gastric ulcer and duodenal ulcer scars at the first endoscopy. He received the same regimen as described above. Ten weeks after completion of the eradication therapy, endoscopy showed healing of the gastric ulcer and relapse of the duodenal ulcer despite successful eradication. These two cases suggest that H. pylori eradication modifies the pathophysiological condition of gastric acid secretion and facilitates relapse of duodenal ulcers. ( info) |
16/465. Ultrasound evidence of gas in the fissure for ligamentum teres: a sign of perforated duodenal ulcer. We present a case of confined duodenal ulcer perforation diagnosed on ultrasound. Locules of gas were visible in the fissure for ligamentum teres along with a small amount of free fluid in Morrison's pouch and thickening of the gall bladder wall. To our knowledge, "free" intraperitoneal gas confined to the fissure for ligamentum teres has not previously been reported as an ultrasound finding in perforated duodenal ulcer. ( info) |
17/465. Acute upper gastrointestinal bleed: a case study. Upper gastrointestinal (UGI) bleeding on a presenting symptom is of major significance for nurse practitioners in any clinical setting. Bleeding in the upper gastric tract is a symptom of a disease process rather than a disease in itself. UGI bleeding accounts for 300,000 hospitalizations annually. An astute knowledge of the pathophysiology and clinical presentations of UGI bleeding enables swift intervention and a reduction in morbidity and mortality rates. This article presents a case report of a white male in his fifties diagnosed with metastatic colon cancer and acute UGI bleeding and emphasizes the need for early screening and detection, disease education, and prompt interventions to minimize associated complications. ( info) |
18/465. Hyperhistaminemia and hyperchlorhydria in basophilic granulocytic leukemia. A patient with basophilic granulocytic leukemia had hyperhistaminemia, hyperchlorhydria and gastroduodenal ulceration. Because the patient's whole blood, plasma, and urinary histamine levels were increased and the serum gastrin was normal, it was concluded that endogenous hyperhistaminemia was responsible for an ulcerogenic diathesis clinically indistinguishable from that seen in the zollinger-ellison syndrome. ( info) |
| Postbulbar duodenal ulceration is not common, but when present is difficult to diagnose and treat. Between January 1965 and September 1971, 1,080 patients with duodenal ulcers were treated surgically at St James Hospital. Forty-one ulcers were found at operation to lie distal to the duodenal bulb. Pain was the most common indication for surgery. In six-patients it was clinically indistinguishable from biliary pain, giving rise to diagnostic difficulty. Twelve patients (29%) presented with haemorrhage, a percentage similar to the 25% of bulbar ulcers presenting with this complication over the period of this study. This is contrary to the finding in most other series, that postbulbar ulceration is more frequently complicated by haemorrhage than is bulbar ulceration. Perforation and stenosis are uncommon complications. Postbulbar ulceration is easily overlooked in conventional barium studies. Only one-third of the patients subjected to barium meal x-ray examination had their ulcers identified in the first study. In a further third the presence of an ulcer was suspected, and the remainder required multiple investigations for undiagnosed symptoms before the condition was demonstrated. duodenoscopy was not performed in a sufficient number of patients for its value to be assessed, but other reports indicate that it should be a valuable manoeuvre. The technical difficulties and potential hazards of Polya gastrectomy are discussed and special reference is made to the surgical management of bleeding postbulbar ulcers. ( info) |
| We report a case of a fistula between a subphrenic abscess and a perforated duodenal ulcer diagnosed by sonography and confirmed by CT. The sonographic findings included a subphrenic fluid collection connected to the anterior aspect of the superior duodenum by a nonpulsatile, anechoic tubular lesion. Manual compression of the upper epigastrium resulted in movement of echogenic debris from the antrum and superior duodenum through the fistulous tract into the abscess. ( info) |