Bleeding duodenal ulcer

Case contributed by Dr Bruno Di Muzio

Presentation

Admitted post mechanical MVR and CABG. Recurrent upper GI bleeding and known duodenal ulcer. Ongoing melena dropped Hb from 90 to 62 despite two units of PRBC; tachycardia, increased noradrenaline.

Patient Data

Age: 70 years
CT

CT Abdomen and Pelvis (GI bleed protocol)

There is active contrast blush within the second portion of the duodenum associated with diffuse duodenal wall thickening. No other haemorrhagic foci identified. Bowel has otherwise unremarkable appearances, with normal mural enhancement. No free fluid or free gas in the peritoneal cavity.

Focal metallic surgical material within the right colon posterior wall. Apart from a simple cyst in the segment VII, liver has normal appearances. The gallbladder, pancreas, adrenal glands, spleen, and kidneys appear unremarkable. Left femoral venous catheter in situ with the tip in the left common iliac vein. Diffuse subcutaneous oedema (anasarca). No suspicious bone lesions. Bilateral pleural effusions, with loculated appearances on the right. 

Case Discussion

This case illustrates active duodenal bleeding due to an ulcer (previously diagnosed on endoscopy). 

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Case information

rID: 53244
Case created: 8th May 2017
Last edited: 8th Jun 2017
Inclusion in quiz mode: Included

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