P0437 - Use of Different Imaging Modalities to Diagnose a Perforated Ulcer: A Case of Ulcer Perfore Bouche

Navkiran Randhawa, DO¹, Alex Yarbrough, DO^2
1Franciscan St. James Hospital, Olympia Fields, IL; ²Franciscan St. James Health, Olympia Fields, IL

Introduction: Peptic ulcer disease refers to a sore that extends through the muscularis mucosa. About 70% of patients initially present asymptomatically. An extensive history and physical exam are needed to manage a PUD to prevent complications. A perforated peptic ulcer is a serious, life threatening complication of PUD that requires emergent surgery and has a high morbidity and mortality risk. We present a unique case of a contained perforated duodenal ulcer.

Case Description/Methods: A 59 year old female with a history of COPD, bronchitis, arthritis with non-steroidal anti-inflammatory who was admitted for worsening, epigastric abdominal pain and nausea that began two days prior to admission. Her bowel movements were melenic and started after the onset of abdominal pain. Physical exam was remarkable for epigastric tenderness without guarding. Basic lab studies revealed a white blood cell count of 23.5 and lactic acid of 2.9. Oher labs were unremarkable. Computed tomography (CT) of abdomen with intravenous contrast revealed haziness and nodularity of the anterior abdominal mesentery without extraluminal air. The admission abdominal X-ray and the x-ray obtained one hour prior to an upper esophagogastroduodenoscopy (EGD) revealed a nonspecific bowel gas pattern (Figure 1A-B). The EGD revealed one non bleeding duodenal ulcer covering half of the duodenal bulb circumference with a cratered area representing a fistula tract (Figure 1C). The fistula tract represented a rare finding of a contained perforation (Ulcere Perfore Bouche). Emergent surgical intervention was initiated with graham patch to treat the contained perforation.

Discussion: Timely diagnosis and emergent surgical intervention of perforated PUD are essential to improve prognosis. This case reports a rare finding of a contained perforated ulcer while also emphasizing the importance of careful endoscopic gas insufflation during diagnostic endoscopy. Significant insufflation in ulcer perfore bouche can worsen perforation. This case also explores the use of oral contrast CT abdomen versus repeat abdominal x-ray in patients with suspected perforated bowel. Two abdominal x-rays were completed however, both images were unable to detect the Ulcer Perfore Bouche. An oral contrast CT abdomen may be a better diagnostic test to diagnose Ulcer Perfore Bouche.



Disclosures:


Navkiran Randhawa, DO¹, Alex Yarbrough, DO². P0437 - Use of Different Imaging Modalities to Diagnose a Perforated Ulcer: A Case of Ulcer Perfore Bouche, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.