Abstract
A 74-year-old man visited our hospital with acute but not intolerable abdominal pain. Upper gastrointestinal endoscopy showed an extended postbulbar ulcer. The patient complained of worsened localized abdominal pain in the right upper quadrant. Abdominal computed tomography showed free air with a fluid collection above the second portion of the duodenum.
Emergency surgery was performed because perforation of the duodenal ulcer or transverse colon was suspected. No fluid collection in the peritoneal cavity was observed at laparotomy. Digestive juices leaked out of the abscess cavity adjacent to the head of the pancreas wrapped in the omental bursa. When the abscess cavity was completely opened, there was a large fissure at the head of the pancreas leaking digestive juices. The fissure was found to lead to the lumen of the duodenum without evident stenosis or a hard tumor. A drainage tube was placed in the duodenum through the anterior wall of the stomach, and the pancreatic fissure was closed. An oral diet was started on postoperative day (POD) 10, and the patient was transferred to another hospital on POD 20. Successful surgical treatment with organ-conservation was performed in a patient with a postbulbar duodenal ulcer penetrating through the head of the pancreas.
