The Clinical Significance of Penetration and Confined Perforation in Peptic Ulcer Disease

Ws, Haubrich; Jl, Roth; Hl, Bockus

doi:10.1016/s0016-5085(19)36259-6

Cited by 26 publications

(1 citation statement)

References 21 publications

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“…By contrast, the confined perforation of a peptic ulcer is defined as the penetration into and confinement within the tissue of an adjacent structure or organ by peptic ulceration. 1 The most common organ involved in the confined perforation is pancreas, followed by gastrohepatic omentum, biliary tract, and liver. 2 Peptic ulcer penetration into the liver is a rare complication that is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Liver Involvement by Perforated Peptic Ulcer: A Systematic Review

Jiao¹,

Zhang²

2021

Journal of Clinical and Translational Pathology

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Background and Objective: Liver penetration by a confined perforation of peptic ulcer is a rare but severe event. Its clinical and pathological features are unclear. Methods: In total, 41 qualified English publications were identified using the PubMed database and one in-house case. Results: Among the 42 patients, 20 patients had liver involvement by a perforated duodenal ulcer and 22 by a gastric ulcer. Among the 23 cases of known ulcer histology, 2 ulcers were malignant and were adenocarcinomas in the gastric remnant and the remaining 21 ulcers were confirmed as histologically benign (for frequency of malignancy in duodenal versus gastric ulcers, p = 0.48). The presence of hepatocytes was the clue of diagnosis for 19 cases. The median ages of the patients were 64.5 years (95% Confidence Intervals [CI] 53.40-71.90) for duodenal ulcer and 65.5 years (95% CI: 59.23-70.95) for gastric ulcer, respectively. The male to female ratio was 1.5:1 for duodenal ulcers and 2:1 for gastric ulcers. Patients with liver involvement of a perforated gastric ulcer were more likely to have a larger ulcer (median largest dimension, 4.75 cm versus 2.5 cm, p = 0.014). Female patients with liver involvement of a gastric ulcer were older than male patients (median age 72 versus 60 years, p = 0.045). There were no differences in gender, region (Asia, Europe, America versus others), use of nonsteroidal anti-inflammatory drugs (n = 15), H. Pylori positivity (n = 10), possible history of peptic ulcer disease (n = 19) or mortality (n = 32) between duodenal and gastric ulcers. Conclusions: Careful histologic examination, clinicopathological correlation, and immunohistochemistry are critical to establish the diagnosis and avoid misdiagnosing liver involvement as malignancy.

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Section: Introductionmentioning

confidence: 99%