Perforated duodenal ulcer presenting with a subphrenic abscess revealed by plain abdominal X-ray films and confirmed by multi-detector computed tomography

A case report

Luigi Camera, Milena Calabrese, Valeria Romeo, Fabrizio Scordino, Pier Paolo Mainenti, Marco Clemente, Gaetano Rapicano, Marco Salvatore

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction. Peptic ulcer disease is still the major cause of gastrointestinal perforation despite major improvements in both diagnostic and therapeutic strategies. While the diagnosis of a perforated ulcer is straightforward in typical cases, its clinical onset may be subtle because of comorbidities and/or concurrent therapies. Case presentation. We report the case of a 53-year-old Caucasian man with a history of chronic myeloid leukemia on maintenance therapy (100mg/day) with imatinib who was found to have a subphrenic abscess resulting from a perforated duodenal ulcer that had been clinically overlooked. Our patient was febrile (38.5°C) with abdominal tenderness and hypoactive bowel sounds. On the abdominal plain X-ray films, a right subphrenic abscess could be seen. On contrast-enhanced multi-detector computed tomography, a huge air-fluid collection extending from the subphrenic to the subhepatic anterior space was observed. After oral administration of 500cm§ssup§ 3§esup§ of 3 percent diluted diatrizoate meglumine, an extraluminal leakage of the water-soluble iodinated contrast media could then be appreciated as a result of a perforated duodenal ulcer. During surgery, the abscess was drained and extensive adhesiolysis had to be performed to expose the duodenal bulb where the ulcer was first identified by methylene blue administration and then sutured. Conclusions: While subphrenic abscesses are well known complications of perforated gastric or duodenal ulcers, they have nowadays become rare thanks to advances in both diagnostic and therapeutic strategies for peptic ulcer disease. However, when peptic ulcer disease is not clinically suspected, the contribution of imaging may be substantial.

Original languageEnglish
Article number257
JournalJournal of Medical Case Reports
Volume7
DOIs
Publication statusPublished - 2013

Fingerprint

Subphrenic Abscess
X-Ray Film
Duodenal Ulcer
Peptic Ulcer
Tomography
Diatrizoate Meglumine
Methylene Blue
Stomach Ulcer
Therapeutics
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Abscess
Contrast Media
Ulcer
Oral Administration
Comorbidity
Fever
Air
Water

Keywords

  • Abdominal plain film
  • Multi-detector computed tomography
  • Peptic ulcer disease
  • Subphrenic abscess

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Perforated duodenal ulcer presenting with a subphrenic abscess revealed by plain abdominal X-ray films and confirmed by multi-detector computed tomography : A case report. / Camera, Luigi; Calabrese, Milena; Romeo, Valeria; Scordino, Fabrizio; Mainenti, Pier Paolo; Clemente, Marco; Rapicano, Gaetano; Salvatore, Marco.

In: Journal of Medical Case Reports, Vol. 7, 257, 2013.

Research output: Contribution to journalArticle

Camera, Luigi ; Calabrese, Milena ; Romeo, Valeria ; Scordino, Fabrizio ; Mainenti, Pier Paolo ; Clemente, Marco ; Rapicano, Gaetano ; Salvatore, Marco. / Perforated duodenal ulcer presenting with a subphrenic abscess revealed by plain abdominal X-ray films and confirmed by multi-detector computed tomography : A case report. In: Journal of Medical Case Reports. 2013 ; Vol. 7.
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