Multiple giant duodenal ulcers associated with duodenal gastrinoma |
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Authors: | Shintaro Fujihara Hirohito Mori Noriko Nishiyama Mitsuyoshi Kobayashi Hideki Kobara Tsutomu Masaki |
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Institution: | (1) Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun Kagawa, 761-0793, Japan |
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Abstract: | A 59-year-old Japanese man with a history of chronic hepatitis C and cirrhosis was admitted to hospital because of severe
abdominal pain and diarrhea. His discomfort had begun 2 months earlier and was localized to the upper abdomen. Upper gastrointestinal
endoscopy showed multiple ulcerative lesions from the duodenal bulb to the descending part of the duodenum, one of which was
a giant ulcer that filled half of the intestinal lumen. Despite continuous intravenous lansoprazole therapy, his abdominal
symptoms did not improve. Upper gastrointestinal endoscopy was again performed to detect the tumor, but it was difficult to
observe the tumor with a conventional endoscope. We then inverted a transnasal endoscope into the duodenum, and this enabled
us to detect a 15-mm submucosal tumor in the upper wall of the duodenal bulb. Examination of specimens from endoscopic ultrasonography
fine-needle aspiration biopsy of the tumor revealed gastrinoma in the duodenal bulb. We decided to perform an operative resection.
The patient’s symptoms resolved after surgery, and he remained asymptomatic at follow-up 18 months later. Therefore, when
it is difficult to detect the tumor directly by conventional endoscopy, we recommend that attempts be made to detect the tumor
by inverting a transnasal endoscope into the duodenal bulb. |
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