Uncomplicated gastric ulcer

Case contributed by Benjamin Jiao
Diagnosis certain

Presentation

Postprandial epigastric pain with nausea and vomiting.

Patient Data

Age: 70 years
Gender: Male
ct

Contrast-enhanced CT of the abdomen and pelvis reveals a focal luminal outpouching with surrounding fat stranding along the lesser curvature of the stomach. No free air or free fluid.

Esophagogastroduodenoscopy

Photo

EGD revealed one non-bleeding cratered gastric ulcer with a clean ulcer base at the incisura. The lesion measured 14 mm in the largest dimension.

Case Discussion

In routine CT studies, evaluation of the stomach and duodenum is often limited by decompression and peristalsis. A dedicated CT may be performed by having the patient fast for six hours and then drinking 500-750ml of water as negative contrast for gastric distention before the examination. Arterial phase contrast should be utilized when gastrointestinal bleeding is suspected. On CT, direct signs of PUD include focal discontinuity of mucosal enhancement and luminal outpouching. Indirect signs include mucosal thickening (which can be focal or diffuse) and adjacent inflammatory fat stranding. Primary differentials include non-inflammatory edema (e.g. anasarca, ascites), pancreatitis, diverticula, and malignancy. Major complications to watch for include active hemorrhage, gastric outlet obstruction, and fistula formation (particularly with posterior duodenal ulcers).

Case courtesy: Ross Kuprien, M.D.

Additional contributor: Zaki Zaheer, D.O.

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