Abstract
Purpose
We diagnosed and treated perforated duodenal ulcers (PDUs) based on the results of ultrasonography (US). We obtained useful ultrasonographic findings regarding the diagnosis and treatment of PDU.
Methods
We experienced 24 PDU cases over 6 years and 4 months (March 2002 to June 2008), and evaluated five useful ultrasonographic findings regarding PDU: (1) Two-way transmigration of liquid and air bubbles through the perforated duodenal wall, (2) hyperechoic band penetration out through the duodenal wall, (3) free air exiting the PDU, (4) fluid exiting the PDU, and (5) liver covering the PDU.
Results
Of the 24 cases, two-way transmigration was observed in 4 cases, hyperechoic band penetration was observed in 18 cases, and exiting free air and fluid was observed in all cases. In all patients with two-way transmigration of liquid and air bubbles, we could immediately diagnose PDU. For the PDU cases falling under categories 2, 3, and 4 above, upon analysis, a large majority provided useful ultrasonographic findings for diagnosing PDU. Of the 5 cases in which the liver did not cover the PDU at all, two-way transmigration of liquid and air bubbles was observed in 4 cases, and surgery was performed in all 5 cases. Of the 19 cases where the PDU was completely covered by the surrounding organs (the liver in 16 cases and fatty organs such as the round ligament or the omentum in 3 cases), nonsurgical treatment was selected in 18 cases. As a result, patients with PDUs covered by surrounding organs, mainly by the liver, received nonsurgical treatment, whereas those with noncovered PDUs underwent surgery.
Conclusion
The findings of ultrasonography are useful for diagnosing and determining the treatment of PDU.
Similar content being viewed by others
References
Nakajo A, Hokita S, Ishigami S, et al. Perforation of gastroduodenal ulcer. Geka 2005;67(9):1013–1016.
Takasu N, Isobe H, Suzuki A, et al. Evaluation of non-operative treatment for perforated gastroduodenal ulcer. J Abdom Emerg Med 2003;23(2):309. (in Japanese).
Ichihara C, Nakano K, Tada T, et al. A case of perforated duodenal ulcer, the treatment of which was determined with ultrasound. J Med Ultrason 2005;32(Suppl):S42. (in Japanese).
Tsujimoto T, Isikawa M, Tsuruzono T, et al. A case of perforated duodenal ulcer diagnosed by ultrasonography. J Med Ultrason 2003;30(3):J369.
Fuji Y, Asao M, Taniguchi N, et al. Sonographic diagnosis and successful non-operative management of sealed perforated duodenal ulcer. J Clin Ultrasound 2003;31(1):55–58.
Coulier B, Maldague P, Broze B. Gastric ulcer penetrating the anterior abdominal wall: ultrasound diagnosis. Abdom Imaging 2003;28:248–251.
Yuasa H, Ide M. Shoukakan eko no mikata kangaekata. Tokyo: Igakushoin; 1998. p. 132. (in Japanese).
Horikawa Y, Iwao N, Yasuda M, et al. CT of acute abdomen. Tokyo: Herusu Shuppan; 1998. p. 341–344.
Ido K, Tosimitu K, Kimura K, et al. Ultrasonic diagnosis of perforated peptic ulcer diseases and conservative therapy based on ultrasonic findings. J Abdom Emerg Med 1997;17(8):1053–1059.
Adati M, Tsuruta R, Ota K, et al. Ultrasound follow-up study of perforated duodenal ulcer treated with omental implantation. Jpn J Med Ultrason 2003;28(4):428–432.
Tomita R. Indication of non-surgical treatment for perforated peptic ulcer. Med Postgrad 2004;42(4):408–411.
Fuke T, Okinaga K, Yokohata T, et al. Indication regarding nonoperative treatment for perforated gastroduodenal ulcer. J Jpn Coll Surg 1997;22(1):12–18. (in Japanese).
Sirai Z, Kamiya T, Kawaguchi H, et al. Clinical features of perforated duodenal ulcer: comparison of operative and nonoperative treatment. Fukuoka University Kiyou 1999;4:231–235. (in Japanese).
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Fukui, H., Fujioka, M., Kajiyama, Y. et al. Feasibility of ultrasonography in determining the diagnosis and treatment of perforated duodenal ulcer. J Med Ultrasonics 36, 83–89 (2009). https://doi.org/10.1007/s10396-008-0214-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10396-008-0214-y