Chapter IV./3: Peptic ulcer penetrating to the pancreas

Kinga Karlinger

IV./3.1.: Introduction

The definition of „ulcerous constitution” is more or less forgotten (however, in case of certain diseases the patient and his/her physical constitution is „blamed” for the development/maintenance of the disease, but these justifications have been vanishing by the exploration of the reasons in the recent times). According to the current knowledge, contribution of many factors can be blamed for the development of the ulcer, among which a Gram negative bacteria, Helicobacter pylori (H. pylori) must be underlined. H. pylori scratches the mucosal barrier, hereby a benign gastric ulcer may develop due to multiple harms.

Stress ulcer; acute ulcer of patients with severe burn of large surface; ulcer developing in severe, acute neurologic disease; uremic ulcer and ulcer in patients with hyperparathyreosis; deeper ulceration following gastritis; ulcer developing after steroid and nonsteroid (based on gastritis) antiinflammatory drug use; and the ulcer related to slow stomach emptying are well known. By these reasons no wonder that the ulcer is often multiple, especially ulcers developing based on gastritis due to drug use. In several cases, peptic ulcer is attendant with a duodenal ulcer. Thanks to the breakthrough of endoscopic procedures and H. pylori eradication, radiological diagnostics and demand for follow-upis rare nowadays.

However, there few examples if radiological imaging is necessary, for ex. if endoscopy cannot be carried out due to constitutional reasons or in case of an operated stomach in which the endoscopist has a very difficult task. Sometimes endoscopists receive an almost impossible task in postoperative situation. In case of lesions (e.g. ulcer penetration – see the presented preparation as well!) where information is necessary about the environment of the stomach as well because of the adjacent structure or organ involved in the process, axial imaging (CT) is necessary to clarify the situation. Radiographic appearence of the classic peptic ulcer depends on the depth of the ulcer as well ont he monocontrast or double contrast studies.

In radiological point of view „superficial ulcer” extends to the mucosal layer only, the deep ulcer („ulcus profundum”) extends to the submucosal layer or beyond, whereas the „penetrating ulcer” (see the presented preparation!) passes through all layers of the gastric wall and penetrates to the sorrounding organs as well. The most frequent habitat of the ulcer is the lesser curvature (Magenstrasse direct draining path of the gastric juice so thus this mucosal surface is principally subjected to irritation) and the body-antrum transition. Old-age ulcers are usually located superiorly.

The chapter structure

• IV./3.1.: Introduction

• IV./3.2.: X-ray

  • IV./3.2.1.: Direct radiographic signs of peptic ulcer

    • IV./3.2.1.1.: Lateral view

    • IV./3.2.1.2.: Anteroposterior view

  • IV./3.2.2.: Indirect radiographic signs of peptic ulcer

  • IV./3.2.3.: Penetrating ulcer

  • IV./3.2.4.: Radiologic signs of malignant ulcer

  • IV./3.2.5.: Radiographic examination of the operated stomach

    • IV./3.2.5.1.: Early postoperative examination

    • IV./3.2.5.2.: Late postoperative examination

    • IV./3.2.5.3.: Radiograph of an operated stomach according to the surgery method

• IV./3.3.: Computed tomography (CT) and ultrasound (US)

• IV./3.4.: Take home messages

References