Tumor mimicking gastric ulcer penetrating asymptomatically into the pancreas
Authors:
P. Macan; J. Geiger; J. Rosendorf; V. Třeška
Authors‘ workplace:
Chirurgická klinika, Fakultní nemocnice Plzeň a lékařská fakulta Univerzity Karlovy v Plzni
Published in:
Rozhl. Chir., 2021, roč. 100, č. 12, s. 612-615.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2021.100.12.612–615
Overview
Gastroduodenal ulcer disease is characterized by ulceration of the stomach or duodenum, with ulcer lesions occurring more frequently in the duodenum. Serious complications of this disease include bleeding, perforation of the ulcer and penetration into surrounding organ. Our report presents the case of an older man who had a gastric ulcer penetrating into the pancreas. This was not diagnosed at the time of the penetration. The patient came to our care for recurrent hematemesis without a proven source of bleeding. During the diagnostic process, the presence of an intramural gastric tumor was suspected. An excision of the suspected lesion was successfully performed at our clinic, followed by histological confirmation of perforated ulcer. The postoperative course was complicated by the development of a pancreatic fistula. However, conservative treatment resulted in complete recovery of the patient.
Keywords:
pancreatic fistula – penetrating peptic ulcer – gastric tumor
Sources
1. Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician. 2007 Oct 1;76(7):1005−1012. PMID: 17956071.
2. Scida S, Russo M, Miraglia C, et al. Relationship between Helicobacter pylori infection and GERD. Acta Biomed. 2018 Dec 17;89(8-S):40−43. doi: 10.23750/ abm.v89i8-S.7918. PMID: 30561416; PMCID: PMC6502218.
3. Satinský I. Perforovaný peptický vřed – předoperační rizika, pooperační morbidita a mortalita, profylaxe v intenzivní péči a doporučení. Anesteziologie a intenzivní medicína 2012;(5):259−263.
4. Woolf A, Rose R. Gastric Ulcer. 2020 Jul 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. PMID: 30725813.
5. Kroupa R, Dítě P, Munzová H. Incidence of gastroduodenal ulcer H. pylori positive and negative in years 1996–2000 in region of Czech Republic. Gut 2002;Suppl II: A63.
6. Moriyama T, Matsumoto T. Esophagogastroduodenal mucosal lesions in patients with inflammatory bowel disease [In Japanese]. Nihon Rinsho 2012 Feb;70 Suppl 1:249?252. PMID: 23126099.
7. Inuzuka T, Okabe Y, Nishikawa H, et al. A case of Zollinger-Ellison syndrome diagnosed by duodenal ulcer perforation into the gallbladder. Gastrointest Endosc. 2013 Apr;77(4):659−660; discussion 660−601. doi: 10.1016/j.gie.2012.11.044. Epub 2013 Jan 26. PMID: 23357498.
8. Tachecí I, Bureš J. Gastroduodenální vředová choroba u diabetika. Vnitřní lékařství 2011;(57(4):347−350.
9. Spiegelhalter DJ, Crean GP, Holden R, et al. Taking a calculated risk: predictive scoring systems in dyspepsia. Scand J Gastroenterol Supp. 1987;128:152–60. doi: 10.3109/00365528709090984.
10. Konečný M. Vředová choroba gastroduodenální. Medicína pro praxi 2017;(14(4):177−179.
11. Charvát D, Leffler J, Hoch J. Chirurgické léčení krvácení z gastroduodenálního vředu. Rozhledy v chirurgii 2007;86(4):166−169.
12. Hoch J, Leffler J. Speciální chirurgie 3., rozš. a přeprac. vyd. Praha, Maxdorf 2011. Jessenius. ISBN 978-80-7345-253-7.
13. Zittel TT, Jehle EC, Becker HD. Surgical management of peptic ulcer disease: indication, technique and outcome. Langenbecks Arch. Surg. 2000;385:84–96.
14. Becker HD, Jehle E, Kreis M. Evaluating elective surgical procedures in ulcer surgery [In German]. Der Chirurg; Zeitschrift fur Alle Gebiete der Operativen Medizen 1996 Jan;67(1):14−19.
15. Maceček J, Tůma J, Prucek T, et al. Asymptomatická penetrace duodenálního vředu do jater u antikoagulovaného pacienta. Interní medicína pro praxi 2013;15:225−228.
16. Bassi C, Dervenis C, Butturini G, et al. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005 Jul;138(1):8−13. doi: 10.1016/j. surg.2005.05.001. PMID: 16003309.
17. Konečný M, Procházka V. Racionální diagnostický a terapeutický postup u akutního krvácení do horní části trávicího traktu. Interní medicína pro praxi 2009;11(10):446−448.
18. Akiyama T, Inamori M, Iida H. Alcohol consumption is associated with an increased risk of erosive esophagitis and Barrett‘ s epithelium in Japanese men. BMC Gastroenterol 2008;118:58.
19. Mincis M, Chebli JM, Khouri ST, et al. Ethanol and the gastrointestinal tract. Arq Gastroenterol. 1995;32(3):131–9.
20. Loveček M, Neoral Č, Klos D, et al. Chirurgie karcinomu pankreatu na I. chirurgické klinice FN Olomouc. Rozhl Chir. 2010;89:731–739.
21. Mensier A, Bounoua F, Beretvas G, et al. Kissing gastric ulcers causing acute pancreatitis and portal biliopathy: what‘s the link? JOP 2013 Nov10;14(6):646−648. doi: 10.6092/1590-8577/1546. PMID: 24216552.
22. Singh T, Mendelson R. Case report: Confined penetration of a duodenal ulcer causing pancreatitis. J Med Imaging Radiat Oncol. 2010 Feb;54(1):47−49. doi: 10.1111/j.1754-9485.2010.02136.x. Erratum in: J Med Imaging Radiat Oncol. 2010 Apr;54(2):171. PMID: 20377715.
23. Fujihara S, Mori H, Nishiyama N, et al. Giant gastric ulcer penetrating into the pancreas. Arab J Gastroenterol. 2012 Sep;13(3):158−160. doi: 10.1016/j. ajg.2012.06.007. Epub 2012 Jul 19. PMID: 23122461.
24. Shibukawa N, Ouchi S, Wakamatsu S, et al. Rare case of gastric ulcer penetrating the pancreas that was successfully managed by conservative therapy. Intern Med. 2017 Sep 1;56(17):2277−2279. doi: 10.2169/internalmedicine.8188-16. Epub 2017 Aug 10. PMID: 28794357; PMCID: PMC5635298.
25. Bae S, Shim KN, Kim N, et al. Incidence and short-term mortality from perforated peptic ulcer in Korea: a population-based study. J Epidemiol. 2012;22(6):508−516. doi: 10.2188/jea.je20120056. Epub 2012 Sep 1. PMID: 22955110; PMCID: PMC3798562.
26. Lanza FL, Chan FKL, Quigley EMM. Practice parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104(3):728–738; doi: 10.1038/ ajg.2009.115
27. Kypraios D, Fusaroli P, Artuso S, et al. Gastric ulcer penetration into the liver mimicking malignancy on endoscopic ultrasound. Endosc Ultrasound. 2013;2(2):107−108. doi:10.4103/2303- 9027.117700.
28. Čečka F, Jon B, Šubrt Z, et al. Pankreatická píštěl − definice, rizikové faktory a možnosti léčby. Rozhl Chir. 2013;92:77−84.
29. Röher HD, Imhof M, Goretzki PE, et al. Ulkus 96 – Methodenwahl im Notfall. Chirurg. 1996;67:20–25.
30. Pimpl W, Boeckl O, Heinermann, et al. Emergency endoscopy: A basis for therapeutic decisions in the treatment of severe gastroduodenal bleeding. World J Surg. 1989;13:592–597.
31. Kujath P, Schwandner O, Bruch HP. Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery. Langenbecks Arch Surg. 2002 Nov;387(7−8):298−302. doi: 10.1007/s00423-002-0331-9. Epub 2002 Nov 8. PMID: 12447556.
32. Svanes C. Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis. World J Surg. 2000 Mar;24(3):277−283. doi: 10.1007/ s002689910045. PMID: 10658061.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2021 Issue 12
Most read in this issue
- Retroperitoneal hematoma: diagnosis and treatment
- Video-assisted and robotic-assisted thoracoscopic pulmonary lobectomies, our experience
- Laparoscopic versus open elective right hemicolectomy with curative intent for colon adenocarcinoma
- Blank spaces in the management of venous thromboembolism prophylaxis at surgical departments and the impact of a clinical pharmacist