Gastric ulcer penetration into liver: A case presentation and review of the literature

Abstract

A 75-year-old man was admitted in the Internal Medicine Department of our Hospital because of weakness and dizziness. His past medical history included COPD and hypertension. Patient was not receiving steroids on daily basis. He was, however, abusing nonsteroidal anti-inflammatory medication due to right elbow and wrist osteoarthritis. Patient

Liver Involvement by Perforated Peptic Ulcer: A Systematic Review

“… 11 Thirteen cases were diagnosed by the direct observation of an ulcer that perforated into the liver during surgery. 4 , 8 , 12 , 21 , 24 , 26 , 27 , 29 , 33 , 34 , 39 , 40 …”

“…49 This analysis showed females with perforated gastric ulcer were significantly older than males, which was consistent with previous reports. 49,52 Unlike the free perforation that has the hallmark presentation of the classic triad (sudden onset of abdominal pain, tachycardia, and abdominal rigidity), the presentation of peptic ulcers with liver penetration is largely nonspecific with abdominal pain or tenderness being the most frequently reported symptoms or indications, and could be more obscure (e.g., dizziness and weakness 29 ). Abnormal liver function as defined by elevated aminotransferase, bilirubin, alkaline phosphatase, gamma-glutamyl transferase and reduced albumin, occurred in 50% of duodenal ulcers and 57% of gastric ulcers and most of the abnormality, especially the elevated aminotransferase, was mild to moderate, which might explain the local non-specific inflammation in the liver.…”

Gastric ulcer with liver penetration

“…Nevertheless, in our case, biopsies were performed more than once without evidence of liver tissue. A previous case, unexpectedly found at surgery, also was preceded by endoscopy where biopsies were hard to obtain because the ulcer base was thick (3). We can therefore hypothesize that it may be difficult to obtain adequate tissue sample of the hard liver surface with conventional biopsy forceps and endoscopic biopsies may have low sensitivity for this complication.…”

Peptic Ulcer Disease: An Unusual Presentation of a Common Problem

“…1 Gastric perforation into the liver is an exceedingly rare complication of peptic ulcer disease and occurs even more infrequently than duodenal perforations. 2 There are only a small number of published case reports in medical literature of gastric ulcer perforations into the liver, 3 with this patient being one of the youngest patients reported to date.…”

“…On examination, the patient was tachycardic at 115 beats per minute and hypotensive at 95/60 mmHg with no signs of peritonism. Laboratory results demonstrated a haemoglobin level of 5.1g/dL, mean corpuscular volume of 87 fL, leukocyte count of 12.4 x10 3 Affecting millions of people worldwide, the incidence of peptic ulcer disease (PUD) varies between patient demographics and country of origin, with its frequency being heavily influenced by the various etiologies of PUD, including H Pylori and NSAID use. Potential major complications of PUD include hemorrhage, penetration, gastric outlet obstruction and perforation.…”