- 作者：Hironori Hayashi ; Hirohisa Kitagawa ; Masatoshi Shoji ; Shin-ichi Nakanuma ; Isamu Makino ; Katsunobu Oyama ; Masafumi Inokuchi ; Hisatoshi Nakagawara ; Tomoharu Miyashita ; Hidehiro Tajima ; Hiroyuki Takamura ; Itasu Ninomiya ; Sachio Fushida ; Takashi Fujimura ; Takashi Tani ; Tetsuo Ohta
- 关键词：Hepatectomy ; Duodenal ulcer ; Proton pump inhibitor ; Penetration ; Hepatoduodenal fistula
- 刊名：International Journal of Surgery Case Reports
- 出版年：2013
- 年：2013
- 卷：4
- 期：12
- 页码：1110-1112
- 全文大小：724 K
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.