Pneumopancreatogram after injection therapy for bleeding duodenal ulcer

Abstract

A 50-year-old woman was admitted with a history of melena in the last 24 h. She reported having suffered intermittent mild mid-epigastric pain, postprandial nausea, and bilious emesis during the past 3 months. She was taking nonsteroidal anti-inflammatory drugs up to 1200 mg per day. On examination she was pale, afebrile, with a regular heart rate at 100 beats/min and a blood pressure of 110/60 mm Hg. She had abdominal tenderness with no signs of guarding. Laboratory data showed the hemoglobin concentration at 7 g/dL and leukocytosis (23 × 109/L). Plain abdominal and chest radiographs were normal. After stabilization, gastroscopy revealed a large duodenal ulcer covered by a nonremovable blood clot and oozing that was effectively controlled by injection therapy with ethanolamine. After endoscopy the patient was in severe pain, and a CT scan of the abdomen revealed pneumopancreas ([Fig. 1]). She responded promptly to conservative medical therapy. The follow-up CT 14 days later showed a marked reduction of the pneumopancreas, with a thin, air-filled fistulous tract between the gastric lumen and the pancreatic duct ([Fig. 2]). Complete healing of the ulcer was achieved with antisecretory therapy. The patient presented 3 months later with jaundice as a result of stricture of the distal common bile duct. Surgical hepaticojejunostomy was performed and she recovered uneventfully and is cholangitis-free, 1 year after the operation.