Case 39-1975

Presentation of CaseA 39-year-old man entered the hospital for evaluation of persistent epigastric pain.Sixteen years previously a diagnosis of duodenal ulcer was made because of epigastric pain and pylorospasm, with delayed emptying, demonstrated on an upper gastrointestinal examination. Episodic pain persisted, and five years later an upper gastrointestinal study (Fig. 1) showed poor coating of the duodenal bulb and narrowing of the second and third portions of the duodenum, with an effaced mucosal pattern; the jejunal mucosal folds appeared thickened. Hemigastrectomy and vagotomy were performed; the small bowel appeared normal; the pathological examination disclosed erosion of the duodenum . . .