2016-04-12 17:28:52 UTC

Image Challenge: Underlying Cause of Duodenal Ulcers

April 13, 2016

The patient's past medical history was notable for prior infection with Helicobacter pylori and Strongyloides, according to this Gastro case.

Question: a 74-year-old Jamaican-born woman presented initially with a three-month history of dyspepsia, nausea, bloating, early satiety and a 40-pound weight loss. Her past medical history was notable for prior infection with Helicobacter pylori and Strongyloides (both of which were treated), acid reflux, diabetes and hypertension. Her medications included metformin, simvastatin and losartan. She underwent an abdominal CT scan that was notable for endometrial cancer. She subsequently had an uncomplicated abdominal hysterectomy.

Her postoperative course was complicated by nausea, anorexia and failure to thrive. On readmission to the hospital 15 days postoperatively, she was noted to have a sodium of 117, albumin of 1.7 and a platelet count of 517,000. The rest of her complete blood count and differential was normal. A CT scan showed small bowel hyperenhancement, edema and anasarca. Stool studies, ova and parasite, and Strongyloides antibodies were all negative.

An EGD was performed that showed large, geographic duodenal ulcers with brownish discoloration of the mucosa. She denied nonsteroidal anti-inflammatory medications. Helicobacter pylori testing was negative. Biopsies were also collected (Figure B, pictured above).

What is the underlying cause of her duodenal ulcers? Visit Gastroenterology to find out and to see other images from this case. 

New App
Also, be sure to keep an eye out for future Gastroenterology clinical image challenges, which will be featured weekly in our new app on AGA App Central starting in May. You will be able to download the app in the Apple app store or on Google Play by searching "AGA App Central".

In addition to the app, you can continue to find clinical image challenges in AGA eDigest and on the AGA website, and in print and online in the Clinical Challenges and Images in GI section of Gastroenterology.

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