S3543 An Unusual Complication of Peptic Ulcer Disease

Abstract

Introduction: In patients with severe peptic ulcer disease (PUD), perforation is a serious complication, often presenting with acute abdominal pain. Perforation occurs in approximately 5% of patients with PUD over their lifetime. Although fistulas have been reported as a potential complication of postoperative perforated peptic ulcer disease, we present a unique case of antral-abscess fistula complicated by duodenal adenocarcinoma. Case Description/Methods: A 57-year-old female presented to the hospital with a chief complaint of epigastric pain. The patient had a history of perforated gastric ulcer status post graham patch repair. Computed Tomography (CT) of abdomen revealed remote gastric perforation with chronic fistulous connection between the gastric antrum and an abscess along the superior margin of the gastric antrum, underneath the left liver. Upper GI endoscopy revealed diffuse mildly erythematous mucosa without bleeding in the stomach as well as non-bleeding large cratered chronic appearing duodenal ulcer with a clean ulcer base (Forrest Class III) in the duodenal bulb involving more than 90% of the duodenal circumference, causing narrowing at the duodenal sweep and 2nd portion of duodenum. There were multiple ulcer/mucosal changes spots of bluish/reddish concerning for non-bleeding visible vessel and fistula given the severity of the ulcer/mucosal changes. Subsequent duodenal ulcer biopsy revealed necrotic tissue with infiltrating cells which were significant for adenocarcinoma of the duodenum (Figure). Discussion: To our knowledge, this is the first report demonstrating antral stomach-abscess fistula with concomitant evidence of duodenal adenocarcinoma after perforated peptic ulcer disease. With this report, we not only aim to shed light on this unique complication but also to spark the scientific community to further investigate potential associations of duodenal adenocarcinoma including peptic ulcer disease.Figure 1.: Endoscopy of duodenum demonstrating ulcerations concerning for non-visible bleeding vessels and fistula.