Giant gastric ulcer (GGU) is defined as an ulcer more than 3 cm in diameter. Now infrequent in clinical practice, in the pre-H2 receptor antagonist (H2RA) era, the incidence of GGU varied between 12 and 24% of all gastric ulcers. Proton pump inhibitors reportedly achieve better healing rates and symptom relief in comparison to H2RA. The GGU is associated with high incidence of serious complications such as hemorrhage. A perforated GGU though rare (<2%) offers serious challenges in management. We report one such case wherein the role of multidetector CT scan (MDCT) for diagnosis and treatment planning, surgical options for GGU perforations, and factors affecting outcome are discussed.
A woman in her early 70s underwent laparoscopic right partial nephrectomy for oncocytoma. During workup, she was found to have an asymptomatic cystic lesion in the right iliac fossa. Fifteen months later, a contrast-enhanced computed tomographic (CT) scan of her abdomen showed a progressive 16-mm cystic lesion in close relation to the cecum (Figure 1). The rest of the colon and small intestine, as well as the adenexa, solid organs, and peritoneum, appeared normal. There was no other positive radiologic finding except for right partial nephrectomy. The general physical and abdominal examinations were unremarkable. The results of other investigations such as a hemogram, liver and kidney function tests, and serum tumor markers, including serum carcinoembryonic antigen levels (0.94 ng/mL [to convert to micrograms per liter, multiply by 1.0]), were within the prescribed normal range. She had good exercise tolerance, and the results of cardiopulmonary investigations, as a part of preanesthesia workup, were normal. Axial view A Planar reconstruction image B R Figure 1. Contrast-enhanced computed tomographic scan of the abdomen showing a cystic lesion (arrowheads) in the right iliac fossa (axial view [A] and planar reconstruction image [B]).
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