Chronic subclinical perforation of a duodenal ulcer presenting with an abdominal abscess in a patient with seronegative rheumatoid arthritis

Abstract

Peptic ulcer disease has been a major problem since the turn of this century with high morbidity and mortality. Perforation is less common, with an estimated incidence of 7-10 per 100 000. We present a young woman with rheumatoid arthritis presenting with anaemia. On work up, she was found to have a chronic abdominal abscess secondary to subclinical perforation of a duodenal ulcer. After undergoing percutaneous drainage, she became haemodynamically unstable and was taken for surgical washout and jejunostomy tube placement. A week later she had a decrease in the size of the abscess and was discharged home with drain and tube feeds. At her follow-up a few weeks later, she was tolerating goal tube feeds.

An Anterior Abdominal Abscess as the Initial Presentation of a Perforated Duodenal Ulcer: A Case Report

“…(3) The patient may be immunocompromised with impaired host response and perception [ 2 ]. Ashfaq et al have described the case of a patient on immunomodulators and steroids for seronegative rheumatoid arthritis who presented with an intrabdominal abscess in the setting of a subclinical duodenal perforation [ 6 ].…”

Absceso secundario a úlcera péptica complicada resuelto mediante drenaje guiado por ecoendoscopia con prótesis de aposición luminal

“…La perforación es menos común, suele manifestarse como un abdomen agudo con hallazgo en TC de neumoperitoneo y precisa cirugía urgente para su tratamiento en la mayoría de los casos. Menos frecuentemente, si la perforación se contiene por órganos vecinos o si tratamientos concomitantes interfieren su curso clínico, puede presentarse de forma más larvada dando lugar a un absceso intraabdominal 3 . Presentamos un caso de absceso intraabdominal secundario a úlcera duodenal perforada con presentación clínica atípica, que pudo resolverse https://doi.org/10.1016/j.gastrohep.2020.04.019 0210-5705/© 2020 Elsevier España, S.L.U.…”