Shu Chinonso Paul, Nwegbu Chukwuemeka G, Ginette Djomo Y A, Brown James Allen
Pan-African Academy of Christian Surgeons, Mbingo Baptist Hospital, Cameroon.
Pan-African Academy of Christian Surgeons, Mbingo Baptist Hospital, Cameroon.
Int J Surg Case Rep. 2025 Feb;127:110942. doi: 10.1016/j.ijscr.2025.110942. Epub 2025 Jan 24.
Upper gastrointestinal bleeding from kissing duodenal ulcers has been reported frequently in elderly patients taking non-steroidal anti-inflammatory drugs (NSAIDs) and steroids but rarely reported in young adults. We reviewed the literature and discussed the management.
We report a case of a 29-year-old Cameroonian male on over-the-counter NSAIDs and steroids, who presented with fatigue, acute abdominal pain, melena, and hematemesis. After resuscitation, esophagogastroduodenoscopy (EGD) revealed a Forest IIB duodenal bulb ulcer. Bleeding could not be controlled locally, necessitating laparotomy, at which time, anterior and posterior perforated duodenal ulcers sealed against the liver and pancreas were found, with active bleeding of the posterior ulcer. The bleeding vessel was over-sewn, followed by an antrectomy and Billroth II gastrojejunostomy. The patient was discharged on the eighth postoperative day and was followed up two weeks later with a satisfactory outcome.
Kissing duodenal ulcers may present in young adults with a history of NSAIDS and steroid use. Perforation may not always be apparent especially if sealed. Urgent EGD does not decrease mortality.
As demonstrated in this index case report, early diagnosis and surgical intervention could be lifesaving in a resource-limited setting.
服用非甾体抗炎药（NSAIDs）和类固醇的老年患者中，十二指肠溃疡导致上消化道出血的情况屡有报道，但在年轻人中却鲜有报告。我们回顾了相关文献并讨论了治疗方法。
我们报告一例29岁喀麦隆男性病例，该患者服用非处方NSAIDs和类固醇，出现疲劳、急性腹痛、黑便和呕血症状。复苏后，食管胃十二指肠镜检查（EGD）显示为福里斯特IIB型十二指肠球部溃疡。局部出血无法控制，因此需要进行剖腹手术，术中发现十二指肠前后壁溃疡与肝脏和胰腺粘连，后壁溃疡有活动性出血。对出血血管进行了缝合，随后进行了胃窦切除术和毕罗II式胃空肠吻合术。患者术后第八天出院，两周后进行随访，结果令人满意。
有NSAIDs和类固醇使用史的年轻人可能会出现十二指肠溃疡。穿孔可能并不总是很明显，尤其是在溃疡已封闭的情况下。紧急EGD并不能降低死亡率。
正如本索引病例报告所示，在资源有限的情况下，早期诊断和手术干预可能挽救生命。
