MedPix® Patient Chart - Case No: 13365 :: - Review Images

This is a 13 y.o. boy with recurrent iron deficiency anemia since age four years, managed with chronic iron supplementation. Recent recurrence of anemia in the last 6 weeks accompanied by epigastric pain, and several episodes of emesis. Two episodes of vomiting contained blood (hematemesis).

Generally well developed, thin, pale male. Abdomen is soft, non-tender, non-distended without masses or organomegaly.

Labs: Hgb 9.8, Hct 32.7, MCV 71.1, Reticulocyte count 2.6, WBC 6.6, platelets 570, stool guaiac positive, CRP 3.86, ESR 23, iron 11.

Amylase and lipase are within normal limits.

- Review Images for PT: 13365

Abdominal ultrasound: Hypoechoic heterogeneous mass in the head of the pancreas extending along the body of the pancreas with reactive lymph nodes anterior to the pancreas head.

Abdominal CT with contrast: Enlarged pancreatic head with edema at the junction of the head and body and disruption anteriorly. Marked gastric wall thickening and distention with a collection of fluid along the posterior stomach wall.

- Review Images for PT: 13365

• Ulcer disease (H. pylori vs hyperacidity)
• Trauma with pancreatic laceration
• Walled-off perforation
• Pancreatic pseudocyst
• Pancreatitis

- Review Images for PT: 13365

Dx: Penetrating gastric ulcer (into pancreas) Helicobacter pylori gastritis

Dx Confirmed by: EGD (Endoscopy) with biopsy

- Read

Started on medical triple therapy and doing well. 6 week follow-up EGD showed healing of ulcer.

EGD:
Large 5 cm ulcer at the antrum of the stomach with penetration into the pancreas.

Pathology:
Inflammatory infiltrate with curvilinear bacilli seen in the crypt lumens and on the surface of the superficial epithelium consistent with Helicobacter pylori gastritis. Postive rapid urease test.