A case of Zollinger-Ellison syndrome diagnosed by duodenal ulcer perforation into the gallbladder

Abstract

A 79-year-old woman presented with abdominal pain. Because of epigastric discomfort she had taken rabeprazole (10 mg/day) for 7 years and had discontinued it 3 weeks previously. She had no history of peptic ulcer disease, nonsteroidal anti-inflammatory drug ingestion, or Helicobacter pylori infection. Laboratory examination showed a white blood cell count of 8150/mm3, hemoglobin of 12.7 g/dL, platelet count of 260,000/mm3, and C-reactive protein of 5 mg/L (<4 mg/L). EGD revealed multiple ulcers in the second part of the duodenum, including a perforation with surrounding yellow mucus (A, arrow).