Fact-sheet: Duodenal ulcer
Updated on 09/17/2021 at 12:16 PM
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Definition
Ulcer: loss of substance of the digestive wall extending into the muscularis
Fibrous scar upon healing
Epidemiology:
-Prevalence: 8% (peptic ulcer disease)
-Decreasing since the early 1990s
-Duodenal ulcer more common than gastric ulcer (4/1)
-Male predominance (sex ratio 3/1)
Predisposing factors:
-H. Pylori gastritis in 90% of cases
-NSAIDs, aspirin
-Smoking, alcohol, stress (ICU)
Duodenal ulcer may heal and recur (60% at 1 year), and may be complicated by: bleeding, perforation (10%)
Clinical features
-Generalized acute peritonitis:
sudden, knife-like epigastric pain becoming diffuse, abdominal guarding,
nausea, vomiting, paralytic ileus
-Localized peritonitis if the ulcer is perforated and sealed off,
apyrexia
CT
Imaging: CT
-Supramesocolic pneumoperitoneum (sometimes minimal),
peri-lesional, subhepatic, and anterior subphrenic
-Falciform ligament sign: gas outlining the falciform ligament
-Duodenal bulb wall thickening, sometimes an ulcer niche, wall discontinuity
-Intramural air bubbles
-Indirect signs:
intraperitoneal effusion (supramesocolic),
peri-lesional fat stranding
Management
Treatment:
Surgical emergency!
