title: Sonographic diagnosis and successful nonoperative management of sealed perforated duodenal ulcer.
abstract: We encountered a case of sealed perforated duodenal ulcer in a 75-year-old woman with rheumatoid arthritis and chronic renal failure. Abdominal sonography showed a bright linear echo within the thickened anterior wall of the duodenal bulb and the presence of free air at the anterior surface of the liver. We found no signs of direct communication between the duodenal lumen and the peritoneal cavity or any free fluid. On follow-up sonography performed every 2 days during the first week of the patient's hospitalization, no free fluid was found in the abdomen. The use of sonography to diagnose this patient's sealed perforated duodenal ulcer and to monitor the ulcer for the appearance of free fluid allowed us to provide successful nonsurgical management to this patient. We believe that the use of abdominal sonography in all patients suspected of having a perforated duodenal ulcer may help increase the diagnostic accuracy of this modality and may reduce the need for surgery in such patients.
authors.affiliation: Department of Clinical Laboratory Medicine, Jichi Medical School, Minami Kawachi-machi, Kawachi-gun, Tochigi 329-0498, Japan.
authors.forename: Yasutomo
authors.initials: Y
authors.lastname: Fujii
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Asato
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Taniguchi
authors.forename: Kouichiro
authors.initials: K
authors.lastname: Shigeta
authors.forename: Kiyoka
authors.initials: K
authors.lastname: Omoto
authors.forename: Kouichi
authors.initials: K
authors.lastname: Itoh
authors.forename: Masayuki
authors.initials: M
authors.lastname: Suzukawa
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004381:Duodenal Ulcer / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006801:Humans; D010439:Peptic Ulcer Perforation / Q000000981:diagnostic imaging* / Q000628:therapy; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging; D014463:Ultrasonography