Stomach Peptic Ulcer: Confined Gastric Perforation

Abstract

Many patients present with epigastic pain as an indication for abdominal sonography. Usually, cholelithiasis or pancreatitis is diagnosed. Nevertheless, some unique other causes of epigastric pain often require several medical modalities before a definitive diagnosis can be made. This case details an elderly patient who complained of epigastric pain from a motor vehicle accident three weeks earlier. The sonographic findings were suggestive of a stomach rupture. Usually, a stomach rupture elicits severe abdominal pain, which was not present in this patient. Computed tomography (CT) was recommended for further investigation. The CT findings were most consistent with a lesser curve gastric ulcer that was contained as a perforation by the lesser sac. Nevertheless, some of the signs were suggestive of a cancerous etiology (enlarged lymph nodes, thick stomach wall). A biopsy was performed to identify the cause. The result of biopsy was peptic ulcer of helicobacter etiology. When scanning patients with epigastric pain, sonographers must be aware of other causes of epigastric pain, such as stomach ulcer perforation, and perform a thorough investigation.