Carcinoma of the pylorus simulating benign duodenal obstruction
- 24 Downloads
Summary and conclusions
Carcinoma of the pylorus may simulate benign duodenal obstruction. Three cases that illustrate some of the pitfalls in the differential diagnosis of duodenal ulcer or pyloric carcinoma are presented. In case 1, medical treatment brought relief of the obstruction, but the correct diagnosis was delayed four and a half months because of inadequate visualization in the progress roentgenologic examinations of the pylorus and the duodenal bulb, and of the lack of cooperation of the patient. In case 2, medical treatment brought no relief of an obstruction associated with a presumed duodenal ulcer of five years' duration, and pyloric carcinoma was found at operation. In case 3, medical treatment brought relief of an obstruction in a patient with a history of duodenal ulcer of 40 years' duration, but the progress roentgenologic examination suggested pyloric carcinoma, which was confirmed at operation. Complete reliance cannot be placed on a history of duodenal ulcer. Persistent obstruction despite intensive medical treatment is suggestive of pyloric carcinoma and makes operation advisable. The relief of the obstruction, conversely, does not rule out pyloric carcinoma.
It is urged that the physician who is medically treating a patient with pyloric obstruction assume the responsibility of making satisfactory progress roentgenologic examinations of the stomach to establish the presence or absence of pyloric carcinoma. Adequate findings usually can be obtained after 14 days of intensive medical treatment.
KeywordsPublic Health Carcinoma Differential Diagnosis Medical Treatment Duodenal Ulcer
Unable to display preview. Download preview PDF.
- 1.Sippy, B. W. Gastric and duodenal ulcer: Medical cure by an efficient removal of gastric juice corrosion.J.A.M.A. 64:1625, 1915.Google Scholar
- 2.Brown, R. C. “Ulcer of the stomach, duodenum and jejunum.”In Christian, H. A.Oxford Medicine. New York, Oxford, 1949, vol. 3, pt. 1, p. 125Google Scholar
- 3.Brown, R. C. The results of medical treatment of peptic ulcer.J.A.M.A. 95:1144, 1930.Google Scholar
- 4.Lahey, F. H. The treatment of gastric and duodenal ulcer.J.A.M.A. 95:313, 1930.Google Scholar
- 5.Collins, E. N., andRossmiller, H. R. Obstructive symptoms versus pyloric obstruction: The importance of medical management.S. Clin. North America 21:1495, 1941.Google Scholar
- 8.Brown, C. H. Medical treatment of the “surgical” or complicated peptic ulcer.J. Oklahoma M. A. 52:289, 1959.Google Scholar
- 10.Brown, C. H., Fisher, E. R., andHazard, J. B. The relation between benign ulcer and carcinoma of the stomach: Report of eight cases of malignant transformation.Google Scholar
- 11.Bockus, H. L. Gastro-Enterology. Philadelphia, Saunders, 1943, vol. 1, p. 647.Google Scholar