Endoscopy 2007; 39: E235-E236
DOI: 10.1055/s-2006-944900
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Pus from the pylorus: an unusual endoscopic finding suggestive of periduodenal abscess

C. C. Chen1 , T. C. Lee2 , K. L. Liu3 , J. T. Lin1 , H. P. Wang4
  • 1Dept. of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
  • 2Dept. of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  • 3Dept. of Medical Imaging
  • 4Dept. of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Further Information

Publication History

Publication Date:
03 August 2007 (online)

Subphrenic intra-abdominal abscess is a well-documented complication of perforated duodenal ulcers [1] [2] [3] [4] [5]. We report here on an unusual endoscopic finding of a sutured perforated duodenal ulcer associated with a subphrenic abscess.

A 32-year-old man in whom a perforated duodenal ulcer had been surgically closed with laparotomy 3 weeks previously presented to our emergency department with symptoms of persistent epigastralgia and fever. At esophagogastroduodenoscopy, abundant whitish pus was noted streaming from the pylorus into the gastric antrum (Figure [1]). The source of the pus was a large duodenal ulcer in the deformed duodenal bulb, where surgical sutures remained (Figure [2]). A reformatted computed-tomographic image identified a fistula (Figure [3]) between a subphrenic abscess and the duodenal bulb, accounting for the origin of the pus stream in the stomach. The patient received percutaneous drainage of the subphrenic abscess, parenteral antibiotics, and proton-pump inhibitors. Therapy to eradicate Helicobacter pylori was prescribed. He made an uneventful recovery without a repeat operation and remained well during a 6-month follow-up period.

Figure 1 Endoscopic image, showing abundant whitish pus streaming from the pylorus into the gastric antrum.

Figure 2 Endoscopic image, showing the pus originating from a sutured duodenal ulcer in the deformed duodenal bulb.

Figure 3 A reformatted computed tomogram, showing a fistula (arrow) communicating between the subphrenic abscess (see additional figure in the right lower corner) and the duodenal bulb.

This case illustrates that a stream of pus in the stomach, particularly when it is accompanied by signs of infection, should suggest to endoscopists the possibility of a subphrenic abscess draining into the gastrointestinal tract.

Endoscopy_UCTN_Code_CCL-1AB-2AZ-3AC

References

H. P. Wang, M. D.

Dept. of Emergency Medicine

National Taiwan University Hospital and National Taiwan University College of Medicine
7 Chung-Shan South Road
Taipei 100
Taiwan

Fax: +886-2-23223150

Email: wanghp@ntu.edu.tw