Fluid-aided sonography of the stomach and duodenum in the diagnosis of peptic ulcer disease in adult patients.

Abstract

Sixty-five patients with a clinical suspicion of peptic ulcer disease were evaluated with fluid-aided sonography (US). The results were compared with endoscopic and upper gastrointestinal (UGI) series findings. Fifteen normal volunteers were examined by US only. The stomach and duodenum were both adequately visualized in 12 of the normal volunteers and in 51 of the study patients. US detected wall abnormalities in 21 of 23 patients (91%) with abnormal UGI series and endoscopy in the antropyloric and duodenal regions, although none of the 17 documented ulcers were visible by US. Abnormalities detected with US included increased wall thickness (mean, 12.85 mm), asymmetric thickening of the mucosa and muscularis, spasm, and deformity. US was considered normal in 25 of 28 patients (89%) with normal UGI series and endoscopy. The results suggest that US may be a useful nonstressful procedure in the evaluation of peptic ulcer disease previously diagnosed by UGI series or endoscopy.

High-frequency ultrasonographic imaging of the gastrointestinal wall

“…For example, in a thin patient with a fluid-filled stomach, a layered structure can be imaged in the healthy stomach and in patients with peptic ulcer disease [4]. Water can even be introduced in to the colon by enema to facilitate transabdominal US delineation of pathological thickening as seen in ulcerative colitis or colorectal cancer [5][6][7].…”

Peptic ulcer perforation: sonographic imaging of active fluid leakage

“…However, several authors have reported cases in which abdominal sonography demonstrated indirect and direct signs indicative of PUP, though most of the indirect signs-such as subphrenic and subhepatic fluid collection, fluid accumulation in the lesser omentum, thickening of the gallbladder wall, an inflammatory mass in the upper abdomen, focal or diffuse thickening, and deformity of the wall of the gastric antrum or duodenal bulb-are not specific for PUP. [3][4][5][6] Furthermore, most of these signs can be more accurately demonstrated with CT. 3 However, CT is an expensive procedure, and it is not as widely available as sonography, thus sonography is often used as a first-line imaging modality in patients with abdominal pain. Lee et al 5 first…”

“…Sonography revealed many of the signs previously reported by other authors. [3][4][5][6] A diffuse thickening of the wall of the gastric antrum and an echogenic linear band traversing the entire thickness of the anterior wall of the prepyloric antrum was demonstrated. The latter was considered to represent a full perforation of the gastric wall with accumulation of blood clots, debris, and air bubbles, as Tsai et al 6 have previously reported.…”

“…Her body temperature was 37. 4 C and her systolic blood pressure was 95 mm Hg. An electrocardiogram revealed sinusal tachycardia.…”

“…Sonography occasionally demonstrates some indirect and nonspecific signs of PUP. [3][4][5] Direct sonographic visualization of a gastric wall perforation is a specific sign of PUP, but this finding is rare and depends on several factors, including the operator's expertise, the site of perforation, and the body habitus of the patient. 6 We report a case of PUP detected via sonography, which revealed indirect signs of PUP, the point of perforation, and active leakage of gastric air/fluid content from the gastric lumen through the perforated gastric wall.…”