Duodenal ulcer penetration into the liver at the previous left hemihepatectomy site☆

Abstract

INTRODUCTION Duodenal ulcer penetration into the liver is a rare, but serious complication. Its frequency was thought to have decreased owing to advances in therapies for peptic ulcers. However, we encountered a case in which the duodenal ulcer had penetrated into a previous hemihepatectomy site. PRESENTATION OF CASE A 69-year-old man with a history of left hemihepatectomy 20 months previously presented to the emergency room with sudden-onset abdominal pain and nausea. An upper gastrointestinal examination with a fiberscope revealed a giant ulcer in the duodenal bulb. In addition, a foreign body was detected at the ulcer floor and was strongly suspected of being a ligature from previous hemihepatectomy. DISCUSSION The presence of a gas-filled liver mass and bowel wall thickening with inflammatory changes are important imaging findings for prompt diagnosis of such a condition, but in this case, none of these were reported. Further, no definite abscess was found. Thus, the patient was treated conservatively with a proton pump inhibitor. CONCLUSION This case demonstrates the importance of using absorbable suture materials, adequate lavage in the postoperative peritoneal space and gastroduodenal mucosal protection postoperatively.

DOI: 10.1016/j.ijscr.2013.09.013

Cite this paper

@inproceedings{Hayashi2013DuodenalUP, title={Duodenal ulcer penetration into the liver at the previous left hemihepatectomy site☆}, author={Hironori Hayashi and Hirohisa Kitagawa and Masatoshi Shoji and Shin-ichi Nakanuma and Isamu Makino and Katsunobu Oyama and Masafumi Inokuchi and Hisatoshi Nakagawara and Tomoharu Miyashita and Hidehiro Tajima and Hiroyuki Takamura and Itasu Ninomiya and Sachio Fushida and Takashi Fujimura and Takashi Tani and Tetsuo Ohta}, booktitle={International journal of surgery case reports}, year={2013} }