Korean J Gastroenterol.  2020 May;75(5):292-295. 10.4166/kjg.2020.75.5.292.

Gastric Ulcer Perforation to the Liver Diagnosed by Endoscopic Biopsy

• Lee SU
• Jee SR
• Lee HS
• Lee SH

• KMID: 2504248
• DOI: http://doi.org/10.4166/kjg.2020.75.5.292

Abstract

Peptic ulcer disease is common and can be diagnosed easily if the patient has an ulcer history or characteristic abdominal symptoms. On the other hand, it may take a long time for the patient to visit the hospital due to severe complications if the patient is old or insensitive to symptoms caused by peptic ulcers. In the present case, a 72-year-old female visited the hospital due to general weakness and inadequate oral intake, which started two weeks ago. Endoscopy and abdominal CT revealed huge gastric ulcer findings. Through a tissue examination by endoscopy, hepatic cells were identified, and the patient was diagnosed with peptic ulcer perforation to the liver and later received surgical treatment.

Keyword

Stomach ulcer; Peptic ulcer perforation; Perforation to the liver; Endoscopic biopsy

Figure

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  Fig. 1 Chest X-ray showing no free air.

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  Fig. 2 (A, B) Abdominal computed tomography shows diffuse wall thickening in the stomach with a suspected ulcerative lesion (arrows) in the lesser curvature side of the gastric antrum and perigastric infiltration.

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  Fig. 3 Endoscopic image shows a large round deep ulcer (A1 stage) at the lesser curvature side of the body. Biopsies were done (arrow for Fig. 4A and asterisk for Fig. 4B).

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  Fig. 4 (A) An endoscopic biopsy demonstrated neutrophils aggregates and necrotic debris, indicative of the findings of an ulcer bed (H&E, ×200). (B) A small piece of biopsied tissue showed fibrotic granulation tissue (upper left) that adhered tightly to hepatic parenchyma (lower right) (H&E, ×200).

Reference

1. Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. 2011; Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 84:102–103. DOI: 10.1159/000323958. PMID: 21494041.

2. Chung KT, Shelat VG. 2017; Perforated peptic ulcer - an update. World J Gastrointest Surg. 9:1–12. DOI: 10.4240/wjgs.v9.i1.1. PMID: 28138363. PMCID: PMC5237817.

3. Silen W. Silen W, editor. 2010. Method of diagnosis: the examination of the patient and the grouping of symptoms and signs. Cope's early diagnosis of the acute abdomen. 22nd ed. Oxford University Press;New York (NY): p. 28–53.

4. Svanes C, Lie RT, Svanes K, Lie SA, Søreide O. 1994; Adverse effects of delayed treatment for perforated peptic ulcer. Ann Surg. 220:168–175. DOI: 10.1097/00000658-199408000-00008. PMID: 8053739. PMCID: PMC1234356.

5. Grassi R, Romano S, Pinto A, Romano L. 2004; Gastro-duodenal perforations:conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol. 50:30–36. DOI: 10.1016/j.ejrad.2003.11.012. PMID: 15093233.

6. Armbruster C, Dittrich K, Kriwanek S. 1989; The place of selective proximal vagotomy in complicated duodenal ulcers. Wien Klin Wochenschr. 101:615–617. PMID: 2815776.

7. Novacek G, Geppert A, Kramer L, et al. 2001; Liver penetration by a duodenal ulcer in a young woman. J Clin Gastroenterol. 33:56–60. DOI: 10.1097/00004836-200107000-00014. PMID: 11418793.

8. Kayacetin E, Kayacetin S. 2004; Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy. World J Gastroenterol. 10:1838–1840. DOI: 10.3748/wjg.v10.i12.1838. PMID: 15188520. PMCID: PMC4572283.

9. Brullet E, Campo R, Calvet X, Gimenez A. 1993; Gastric ulcer penetrating to the liver: endoscopic diagnosis. Am J Gastroenterol. 88:794–795. PMID: 8480764.

10. Oka A, Amano Y, Uchida Y, et al. 2012; Hepatic penetration by stomal ulcer: rare complication of a peptic ulcer. Endoscopy. 44 Suppl 2 UCTN:e347–e348. DOI: 10.1055/s-0032-1309920. PMID: 23012015.

11. Lesquereux-Martínez L, Álvarez AM, Parada-González P, Bustamante-Montalvo M. 2017; Gastric ulcer penetrating the liver. Cir Esp. 95:46. DOI: 10.1016/j.ciresp.2016.02.003. PMID: 26987967.

12. Hayashi H, Kitagawa H, Shoji M, et al. 2013; Duodenal ulcer penetration into the liver at the previous left hemihepatectomy site. Int J Surg Case Rep. 4:1110–1112. DOI: 10.1016/j.ijscr.2013.09.013. PMID: 24240081. PMCID: PMC3860026.