1/55. Double pylorus.We report a 55-year-old man presenting with postprandial epigastric pain and vomiting. barium meal study suggested two openings from the stomach to the duodenum. endoscopy revealed double pylorus with chronic duodenal ulcer, suggesting the second opening as an acquired one.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/55. pneumoperitoneum caused by a perforated peptic ulcer in a peritoneal dialysis patient: difficulty in diagnosis.peritonitis due to viscus perforation in peritoneal dialysis (PD) patients can be catastrophic. We describe the first reported case of perforated peptic ulcer (PPU) in a PD patient. This 78-year-old man presented with a 1-day history of mild abdominal pain. He had been receiving nocturnal intermittent PD for 2 years and had ischemic heart disease and cirrhosis of the liver. pneumoperitoneum and peritonitis were documented, but the symptoms were mild. The "board-like abdomen" sign was not noted. air inflation and contrast radiography indicated a perforation in the upper gastrointestinal tract, and laparotomy disclosed a perforation in the prepyloric great curvature. Unfortunately, the patient died during surgery. This case illustrates that the "board-like abdomen" sign may be absent in PD patients with PPU because of dilution of gastric acid by the dialysate. Free air in the abdomen, although suggestive of PPU, is also not uncommon in PD patients without viscus perforation. Because PD has to be discontinued after laparotomy and exploratory laparotomy may be fatal in high-risk patients, other diagnostic methods should be used to confirm viscus perforation before surgery. PPU, which can be proved by air inflation and contrast radiography, should be suspected in PD patients with pneumoperitoneum and peritonitis.- - - - - - - - - - ranking = 9.1012846681727keywords = abdominal pain, pain, upper (Clic here for more details about this article) |
3/55. Direct sonographic signs of acute duodenal ulcer.Sonography was performed in two patients with acute epigastric pain. Isolated thickening of the duodenal wall with an echogenic line within were considered to be signs of duodenal ulcer in keeping with a suggestive clinical background. The extension of this line beyond the duodenal wall and the periduodenal fluid were indicators of perforation. The images in our two patients indicate the usefulness of ultrasonography when performed carefully in selected cases.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
4/55. Postbulbar duodenal ulcer.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.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
5/55. Sonographic diagnosis of a small fistulous communication between a subphrenic abscess and a perforated duodenal ulcer.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.- - - - - - - - - - ranking = 0.26485631116915keywords = upper (Clic here for more details about this article) |
6/55. Perforated peptic ulcer in an infant.We describe a case of perforated peptic ulcer (PPU) in a 9-month-old boy. Abdominal distension was the first clinical sign of PPU. Before he developed abdominal distension, the patient had suffered from an upper respiratory tract infection with fever for about 2 weeks, which was treated intermittently with ibuprofen. A plain abdominal radiograph revealed pneumoperitoneum with a football sign. At laparotomy, a 0.8-cm perforated hole was found over the prepyloric area. Simple closure with omental patching was performed after debridement of the perforation. Pathologic examination showed chronic peptic ulcer with helicobacter pylori infection. The postoperative course and outcome were satisfactory. The stress of underlying disease, use of ibuprofen, blood type (A), and H. pylori infection might have contributed to the development of PPU in this patient. PPU in infancy is rare and has a high mortality rate; early recognition and prompt surgical intervention are key to successful management.- - - - - - - - - - ranking = 0.26485631116915keywords = upper (Clic here for more details about this article) |
7/55. death from hypovolemic shock caused by perforation of duodenal ulcer in a patient with angiosarcoma of the scalp.We report a case of an 86-year-old woman with angiosarcoma on the scalp, who died from hypovolemic shock caused by perforation of a duodenal ulcer. A purple-red macule was first noticed on her left temporal scalp, and over a 1-month period this macule rapidly grew to a 6 cm purple-red indurated plaque with hematomas. The diagnosis of angiosarcoma was made based on the clinical features and histopathological finding of the lesional skin. Perilesional injections of recombinant interleukin 2 (rIL-2) were followed by surgical resection of the lesion and graft repair. However, 5 months later, new hematomas appeared and increased in number and size to cover her cheek, left temporal scalp and around the grafted area. Electron-beam radiotherapy showed only a temporary effect and the skin lesions with spontaneous severe bleeding extended rapidly again toward a wide region of the left half of the scalp and cheek. The patient died of hypovolemic shock after acute abdominal pain with intestinal hemorrhage. The surgical pathology revealed the presence of a perforated duodenal ulcer which might have been the direct cause of hypovolemic shock.- - - - - - - - - - ranking = 8.8364283570036keywords = abdominal pain, pain (Clic here for more details about this article) |
8/55. diagnosis of perforated gastric ulcers by ultrasound.patients with a perforation of the gastrointestinal tract need fast confirmation of diagnosis and early treatment to improve outcome. Plain abdominal x-ray does not always prove the perforation particularly at early stage. We report about a 62 year-old woman complaining of consistent abdominal pain with sudden onset. Ultrasound was taken as first diagnostic measure, revealing a perforation. The leakage was located in the stomach. radiography confirmed the pneumoperitoneum without indicating the perforated location. During operation the perforated gastric ulcer was found and sutured. This case report points out the reliability of ultrasound in diagnosing a pneumoperitoneum. Additionally it provides a summary of ultrasound signs seen in perforated gastric and duodenal ulcers and a review of literature.- - - - - - - - - - ranking = 8.8364283570036keywords = abdominal pain, pain (Clic here for more details about this article) |
9/55. pneumopericardium due to intrapericardial perforation of a gastric ulcer.A 88-year-old male patient presented with fever, singultus and retrosternal pain. After 8 days of antibiotic therapy not resulting in clinical improvement, he suddenly developed a pneumopericardium. Contrast swallow and endoscopy showed intrapericardial perforation of a benign gastric ulcer. Excision of the ulcer and suturing of both the stomach and the diaphragm as well as lavage of the pericardium were done over a left thoracotomy. The patient recovered uneventfully.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
10/55. Cervical epidural abscess secondary to aorto-duodenal fistula: a case report.Although cervical epidural abscess is rare, it should be strongly suspected in any patient with unexplainable neck pain and fever, especially when the patient has a predisposing factor for this infectious process. The authors report a case of cervical epidural abscess in a 39-yr-old man with an aorto-duodenal fistula, which complicated the interposition of artificial graft for abdominal aortic aneurysm rupture, which had undertaken 40 months before. Timely detection and intervention rendered him a full neurological recovery. This extremely rare case is presented with a literature review.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
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