A CASE OF GASTRODUODENAL ULCER PRESENTED WITH WHOLE-CIRCUMFERENCE STENOSIS OF THE PYLORIC VESTIBULE

Abstract

We describe a case of gastroduodenal ulcer in which pyloric vestibular stenosis exacerbated in a short time and we had difficulties in differentiation from advanced gastric cancer.The case was a 71-year-old male who had had head injury and was being medicated for sustaining headache. On October 16, 1989, the patient was admitted to our hospital because of melena. Upper gastrointestinal series revealed a probable advanced gastric cancer. Borrmann type 4. Biopsy cytology, however, showed no malignant findings. Because of markedly exacerbated stenosis at the pyloric vestibule, pyloric-side gastrectomy and duodenectomy were carried out on November 22. In the excised specimen, giant girdle ulcer (Ul-II) in 3 lines at the lesser curvature, anterior and posterior wall of lower body of stomach, and a whole-circumference stenosis 7 cm in length reaching to the duodenal bulb at the anal-side were observed. Histopathological findings included mild inflammatory findings at mucous membrane, submucosal proliferation of collagen fiber, and marked hypertrophy of intrinsic muscle layer at the whole-circumference stenosis site. This pyloric vestibular stenosis might be due to repeated chronic inflammation. Possible factors causing exacerbation can be medication and circulatory disturbance.