Giant Duodenal Ulceration

Abstract

Dr.Robert J. Cihak: This 86-year-old man was admitted to this hospital with a history of increasing dyspnea for two months. Recently he noted intermittent abdominal pain which radiated to the back. He did not have a history of vomiting, nor was he jaundiced. His hematocrit reading was 32; white blood cell count, 13,000/cu mm; and the guaiac test on the stool was positive. Examination of the upper gastrointestinal tract was performed at the time of admission. Discussion Dr. Laurence L. Robbins: Dr. Shea, would you discuss this case? Dr. Thomas E. Shea: The obvious abnormality is in the area of the duodenal bulb which contains a grossly irregular collection of barium sulfate (Figure). There is no mucosal pattern within it. Several possibilities come to mind. Giant duodenal ulcer should be considered, particularly if there is a past history of peptic ulcer disease. That entity demonstrates a very large, globular