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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.
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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.
• Ulcer disease (H. pylori vs hyperacidity) • Trauma with pancreatic laceration • Walled-off perforation • Pancreatic pseudocyst • Pancreatitis
Penetrating gastric ulcer (into pancreas) Helicobacter pylori gastritisDiagnosis Confirmed by: EGD (Endoscopy) with biopsy
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Tx and Followup:Started on medical triple therapy and doing well. 6 week follow-up EGD showed healing of ulcer.
Additional Discussion: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.
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The Department of Radiology and Radiological Sciences Uniformed Services University Bethesda, Maryland 20814.
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- Penetrating gastric ulcer (into pancreas) Helicobacter pylori gastritis
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