Duodeno-pleural fistula: a rare complication of peptic ulcer perforation

Duodenopleural fistula is a very uncommon complication of peptic ulcer perforation and usually follows empyema after a subdiaphragmatic abscess rupture. We present a rare case of duodenopleural fistula following subdiaphragmatic abscess, which resulted in thoracic empyema after gastric perforation.     

Sonographic detection of duodenal ulcer.

Using a wall thickness of greater than 5 mm for the first portion of the duodenum as the criterion for the sonographic diagnosis of duodenal ulcer, we studied the value of sonography in detecting this lesion. Endoscopy (88 patients) and upper gastrointestinal barium studies (12 patients) were used as the gold standards for the diagnosis. The study included 100 patients in whom gastrointestinal disease was suspected (20 with duodenal ulcer and 80 with normal findings). Of the 20 duodenal ulcers verified by endoscopy or upper gastrointestinal series, 13 patients had duodenal wall thickening, six had normal wall thickness, and one was nondiagnostic. Of the 80 subjects with normal findings on endoscopy or upper gastrointestinal series, 73 patients had a normal duodenum, four had wall thickening, and three were nondiagnostic. Considering the four nondiagnostic cases as sonographic errors, there were six false-negative cases and four false-positive cases (a sensitivity of 65%, specificity of 91%, positive predictive value of 76%, and negative predictive value of 92%). Our results show that sonography is not sufficiently sensitive to be used as a screening test, nor is it specific for duodenal ulcer, but a thickened duodenal wall of over 5 mm on sonography warrants additional work-up.     

Post-bulbar duodenal ulcer with anterior perforation with kissing ulcer and duodenocaval fistula: A case report and review of literature

BACKGROUNDA post-bulbar duodenal ulcer (PBDU) is an ulcer in the duodenum that is distal to the duodenal bulb. PBDU may coexist with a synchronous posterior ulcer in rare occurrences, resulting in a kissing ulcer (KU). Duodenocaval fistula (DCF) is another uncommon but potentially fatal complication related to PBDU. There is limited knowledge of the scenarios in which PBDU is complicated by KU and DCF simultaneously.CASE SUMMARYA 22-year-old man was admitted to the emergency department with abdominal pain, stiffness, and vomiting. The X-ray showed pneumoperitoneum, suggesting a perforated viscus. Laparotomy revealed a KU with anterior perforation and a DCF. After Kocherization, venorrahphy was used to control caval bleeding. Due to the critical condition of the patient, only primary duodenorrahphy with gastrojejunostomy was performed as a damage control strategy. However, later, the patient developed obstructive jaundice and leakage, and two additional jejunal perforations were detected. Due to the poor condition of the duodenum and the involvement of the ampulla in the posterior ulcer, neither primary repair nor pancreatic-free duodenectomy and ampulloplasty/ampullary reimplantation were considered viable; therefore, an emergency pancreaticoduodenectomy was performed, along with resection and anastomosis of the two jejunal perforations. The patient had a smooth recovery after surgery and was discharged after 27 d. CONCLUSIONThe timely diagnosis of PBDU and radical surgery can aid in the smooth recovery of patients, even in the most complex cases.     

Gastrojejunal fistula: a complication of peptic ulcer disease

Spontaneous gastrojejunal fistula formation is rare and its differential diagnosis multifactorial. Precise etiologic determination is necessary for proper management. We have reported a case typical of gastrojejunal fistula due to peptic ulcer disease. In contrast to the gastrocolic fistula, symptoms of the gastrojejunal fistula are those of the ulcer diathesis itself. The preferred management is by en bloc one-stage resection after preoperative colon preparation.