Feasibility of ultrasonography in determining the diagnosis and treatment of perforated duodenal ulcer.
OBJECTIVE
We diagnosed and treated perforated duodenal ulcers (PDUs) based on the results of ultrasonography (US). We obtained useful ultrasonographic findings regarding the diagnosis and treatment of PDU.


METHODS
We experienced 24 PDU cases over 6 years and 4 months (March 2002 to June 2008), and evaluated five useful ultrasonographic findings regarding PDU: (1) Two-way transmigration of liquid and air bubbles through the perforated duodenal wall, (2) hyperechoic band penetration out through the duodenal wall, (3) free air exiting the PDU, (4) fluid exiting the PDU, and (5) liver covering the PDU.


RESULTS
Of the 24 cases, two-way transmigration was observed in 4 cases, hyperechoic band penetration was observed in 18 cases, and exiting free air and fluid was observed in all cases. In all patients with two-way transmigration of liquid and air bubbles, we could immediately diagnose PDU. For the PDU cases falling under categories 2, 3, and 4 above, upon analysis, a large majority provided useful ultrasonographic findings for diagnosing PDU. Of the 5 cases in which the liver did not cover the PDU at all, two-way transmigration of liquid and air bubbles was observed in 4 cases, and surgery was performed in all 5 cases. Of the 19 cases where the PDU was completely covered by the surrounding organs (the liver in 16 cases and fatty organs such as the round ligament or the omentum in 3 cases), nonsurgical treatment was selected in 18 cases. As a result, patients with PDUs covered by surrounding organs, mainly by the liver, received nonsurgical treatment, whereas those with noncovered PDUs underwent surgery.


CONCLUSIONS
The findings of ultrasonography are useful for diagnosing and determining the treatment of PDU.
Department of Surgery, Daito Central Hospital, 2-1-11 Ono, Daito, Osaka, 574-0042, Japan. daito1@daito-central-hp.com.
Hiroya
H
Fukui
Department of Clinical Laboratory, Daito Central Hospital, Daito, Japan.
Masayuki
M
Fujioka
Department of Surgery, Daito Central Hospital, 2-1-11 Ono, Daito, Osaka, 574-0042, Japan.
Yuji
Y
Kajiyama
Department of Surgery, Daito Central Hospital, 2-1-11 Ono, Daito, Osaka, 574-0042, Japan.
Takeshi
T
Uemichi
Department of Surgery, Daito Central Hospital, 2-1-11 Ono, Daito, Osaka, 574-0042, Japan.
Shinichi
S
Mikami
Department of Internal Medicine, Daito Central Hospital, Daito, Japan.
Chison
C
Kou
Department of Internal Medicine, Daito Central Hospital, Daito, Japan.
Shousaku
S
Asaka
Osaka Clinic, Hankyu Corporation, Osaka, Japan.
Tatsuhiko
T
Oohara
Department of Surgery, Daito Central Hospital, 2-1-11 Ono, Daito, Osaka, 574-0042, Japan.
Norihiko
N
Usui
diagnosis; perforated duodenal ulcer; treatment; ultrasonography