Bleeding peptic ulcer

Case contributed by Dr Henry Knipe

Presentation

Abdominal pain. Blood results show high lactate, low haemoglobin, and acidosis.

Patient Data

Age: 70 years
Gender: Male
Modality: CT

Bleeding peptic ulcer in the duodenal bulb. Associated bowel wall thickening and fat stranding. No free gas or extraluminal (i.e. peritoneal) haemorrhage. On portal venous phase imaging there is pooling of contrast in the distal duodenum and proximal jejunum.

Most likely bleeding point is the gastroduodenal artery arising from the left hepatic artery. Replaced right hepatic artery is noted. 4 cm infrarenal abdominal aortic aneurysm with mural thrombus. 

Inferior midline ventral hernia containing non-obstructed large and small bowel, and omental fat.

Case Discussion

Peptic ulcers are the most common cause of non-variceal upper gastrointestinal bleeding. Other common causes include erosive gastritis, Mallory-Weiss tears, reflux oesophagitis, and angiodysplasia. 

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Case Information

rID: 42912
Case created: 14th Feb 2016
Last edited: 7th Oct 2016
Inclusion in quiz mode: Included

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