Duodenal ulcer penetration into the liver at the previous left hemihepatectomy site.
BACKGROUND
Duodenal ulcer penetration into the liver is a rare, but serious complication. Its frequency was thought to have decreased owing to advances in therapies for peptic ulcers. However, we encountered a case in which the duodenal ulcer had penetrated into a previous hemihepatectomy site.


METHODS
A 69-year-old man with a history of left hemihepatectomy 20 months previously presented to the emergency room with sudden-onset abdominal pain and nausea. An upper gastrointestinal examination with a fiberscope revealed a giant ulcer in the duodenal bulb. In addition, a foreign body was detected at the ulcer floor and was strongly suspected of being a ligature from previous hemihepatectomy.


CONCLUSIONS
The presence of a gas-filled liver mass and bowel wall thickening with inflammatory changes are important imaging findings for prompt diagnosis of such a condition, but in this case, none of these were reported. Further, no definite abscess was found. Thus, the patient was treated conservatively with a proton pump inhibitor.


CONCLUSIONS
This case demonstrates the importance of using absorbable suture materials, adequate lavage in the postoperative peritoneal space and gastroduodenal mucosal protection postoperatively.
Department of Gastroenterologic Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan. Electronic address: pwrofdrms2000@staff.kanazawa-u.ac.jp.
Hironori
H
Hayashi
Hirohisa
H
Kitagawa
Masatoshi
M
Shoji
Shin-Ichi
S
Nakanuma
Isamu
I
Makino
Katsunobu
K
Oyama
Masafumi
M
Inokuchi
Hisatoshi
H
Nakagawara
Tomoharu
T
Miyashita
Hidehiro
H
Tajima
Hiroyuki
H
Takamura
Itasu
I
Ninomiya
Sachio
S
Fushida
Takashi
T
Fujimura
Takashi
T
Tani
Tetsuo
T
Ohta
Duodenal ulcer; Hepatectomy; Hepatoduodenal fistula; Penetration; Proton pump inhibitor