A Case of Gastric Ulcer Penetration of the Pancreas Complicated by Hemorrhagic Shock

Abstract

A 72-year-old woman presented to the emergency room with fatigue. Her face was pale, and her level of consciousness was reduced. Blood studies revealed severe anemia, and computed tomography showed a large gastric ulcer and absence of pre-pancreatic fatty tissue. A diagnosis of gastric ulcer penetration of the body of the pancreas complicated by hemorrhagic shock was made, and emergency laparotomy was performed. Intraoperatively, an ulcer on the posterior wall of the gastric angle was seen to have penetrated the body of the pancreas, and it was impossible to dissect due to the presence of firm adhesions. Gastrectomy with distal pancreatectomy was considered, but in view of the patient’s age and general condition, partial gastrectomy was performed, leaving the floor of the ulcer on the surface of the pancreas. A pancreatic fistula was observed postoperatively and required endovascular treatment. The patient was discharged on postoperative day 128. Penetration of the pancreas by a gastric ulcer may necessitate pancreatectomy, which requires careful consideration of the surgical procedure. A case of a perforated gastric ulcer with penetration of the pancreas complicated by hemorrhagic shock that was managed successfully without performing a pancreatectomy is reported.