A 80-year-old man was admitted to our hospital because of epigastralgia and tarry stool. Endoscopic findings showed circular ulceration in the anal side of the duodenal bulb and postbulbar region with coagulation accompanied by the multiple ulcers in the descending part of the duodenum. He did not take any medicine such as nonsteroidal anti-inflammatory drug and did not suffer from any stress. He was treated with an H2-recepter antagonist. Three weeks after admission, ulcers were almost healed. Six weeks later, endoscopic findings showed ulcer scars and mild stricture in the postbulbar region. We observed him during a year and ulcers were not recurred.
Acute multiple duodenal ulcer is sometimes reported, but the circular ulceration is rare. The cause is usually presumable but our case is not. We assume this ulcer is due to ischemia of the duodenal mucosa, because the patient is arteriosclerotic and the circular ulceration is similar to ischemic colitis. But no stricture and occlusion was able to found in the superior and inferior pancreaticoduodenal arteries with our angiographic study. We conclude that we must evaluate microcirculation of mucosa of the alimentary tract when we examine a similar ulceration to our case.
