43-year-old male suffered from stabbing epigastric pain 90-180min after intake of a meal. Finally, acute massive gastro-intestinal bleeding required emergency surgery.
- Sharply delineated, punched-out wall defect with mucosal folds extending to its margins. To one side, mucosa of the duodenum with submucous Brunner glands can be identified.
- Ulcus destroys not only mucosa, but may extend into muscularis mucosae, externae and subserosa.
- A chronic peptic ulcer displays four more or less well defined layers:
(1) Surface coat of cellular debris, fibrin, neutrophilic granulocytes and blood.
(2) Fibrinoid necrosis of underlying tissue (effect of hydrochloric acid)
(3) Granulation tissue (reaction of the organism; organisation of the defect)
(4) Fibrosis of the muscle wall sometimes extending into subserosa.
- On occasion, a vessel with an open lumen may be observed at the base of the ulcus (source of bleeding).
- Inflammatory infiltrates in adjacent mucosa.
Complications of a duodenal ulcer, depending on the localization:
1. Acute bleeding due to erosion of the pancreatic-duodenal artery.
2. Duodenal perforation with peritonitis.
3. Penetration into the pancreas with ensuing acute pancreatitis.