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.
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.
â€¢ Ulcer disease (H. pylori vs hyperacidity)
â€¢ Trauma with pancreatic laceration
â€¢ Walled-off perforation
â€¢ Pancreatic pseudocyst
Dx: Penetrating gastric ulcer (into pancreas) Helicobacter pylori gastritis
Dx Confirmed by: EGD (Endoscopy) with biopsy
Started on medical triple therapy and doing well. 6 week follow-up EGD showed healing of ulcer.
Large 5 cm ulcer at the antrum of the stomach with penetration into the pancreas.
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.
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