Linear Ulcer of the Duodenal Bulb, Especially its Circular Line Ulcer T. Takemoto 1 , M. Maruyama 1 , A. Yamada 2 1The Institute of Gastroenterology, Tokyo Women's Medical College pp.1638-1642
Published Date 1973/12/25
DOI https://doi.org/10.11477/mf.1403108415
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 As no definite criteria have been established yet regarding linear ulcer of the duodenum, we have considered endoscopically those ulcers that have a length about more than one fourth of the mural circumference as linear ulcer and the other long ulcers as either line-shaped or linear-like ulcer. When an ulcer is so elongated as to extend to almost the entire circumference of the wall, causing ring-like deformity of the bulb and roentgenologically recognized as hourglass-like deformity, we call it a circular line ulcer, as is exemplified in this paper.

 The patient, a 46-year-old woman, had a previous history of gastric ulcer diagnosed 10 years before. Since then every year in May or June she had suffered periodically from pain in the epigastrium and heartburn. Toward the end of December 1972 she was found to harbor duodenal ulcer at an x-ray examination of the digestive tract, so that she was reterred to our Center. Gastric analysis with 4μg/kg tetragastrin demonstrated hyperhydrochlorhydria, that is one-hour total acid output after stimulation revealed 21.39 mEq/hr.

 Endoscopy revealed a ring-like deformity of the duodenal bulb extending to almost the whole circumference of the wall. A long linear ulcer was seen to start from the anterior wall along it, coursing transversely to the lesser curvature, and on reaching the posterior wall to curve toward the greater curvature, finally ending there near the anterior wall. Bariumfilled x-ray picture showed sharp incisurae on both sides of the bulb, but mucosal relieves tugged from just behind the pyloric ring were not conspicuous, so that the entire bulb looked deformed like an hourglass. It was difficult to depict the long linear ulcer in double contrast picture, but compression made it possible to delineate a linear shadow that suggested a linear ulcer.

 Observation of such a long ulcer is now sufficiently done by the introduction of GIF-D or PFS that permits one to see satisfactorily the greater curvature side. During the period November 1971 through July 1973 we have come across 566 cases of ulcer in the duodenal bulb observed by endoscopy, but we have encountered only a single case of such a long ulcer. In the course of its development the present ulcer showed at one time a picture of shorter linear ulcer linking both sides of kissing ulcer. Perhaps it suggested a formation process of linear ulcer. The area of the circular line ulcer was not strictured as it allowed the endoscope to pass through. How it may undergo morphological changes in the future is very interesting.

Copyright © 1973, Igaku-Shoin Ltd. All rights reserved.


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