A “Double Route” to Duodenum: The Unusual Case of Healing’s Bleeding Ulcer
ADVANCED RESEARCH IN GASTROENTEROLOGY & HEPATOLOGY JUNIPER PUBLISHERS Authored by Valeria D’Ovidio Case Report A 79-year-old woman was admitted to the emergency room of our hospital for hematemesis and syncope(Hb was 9.9 g/dl). She referred chronic use of NSAID (Non-Steroidal Anti-Inflammatory Drugs) for arthralgia without any concomitant proton pump inhibitors (PPIs). An EGDS (Esophagogastroduodenoscopy) was promptly performed and a 25 mm, actively bleeding pre-pyloric antral ulcer was diagnosed (Forrest 1b). A combined endoscopic treatment (epinephrine submucosal injection + clip placement) was successfully performed. A rapid urease test was negative. The patient was further treated with high dose of intravenous PPIs until she left hospital. Bleeding did not recur, and Hb level remained stable. At 1 month, a follow up EGDS was performed and a pre-pyloric fistula was highlighted. The duodenum could easily be entered via both of the pyloric channels. ...