duodenal ulcer

• 2-3 x more frequent than gastric ulcers; M:F = 3:1
• secondary to increased acid in duodenum
• predisposed: cortisone, cerebral injury, surgery, COPD

• location: bulbar (95%), postbulbar (3-5%)

• findings:
  • small, round/ovoid/linear ulcer niche
  • "kissing ulcers": ulcers opposite from each other
  • giant duodenal ulcer >3 cm (rare): high morbidity; may be overlooked by simulating deformed bulb
  • "clover-leaf deformity"; "hourglass stenosis" (healed stage)

• complications:
  • obstruction (5%)
  • perforation (<10%): anterior > posterior wall
  • penetration (<5%) = sealed perforation
  • hemorrhage (15%): melena > hematemesis

© 2002, C.E. Kahn, Jr.
2002-04-18