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

Affiliations
  • 1Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

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

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

  • 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.

  • 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).

  • 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).


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