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Image of the Month—Quiz Case
Tomonori Iida, MD;
Haruyuki Akita, MD, PhD;
Masasi Sasaki, MD, PhD;
Nobuyoshi Hanyu, MD, PhD;
Katsuhiko Yanaga, MD, PhD
Arch Surg. 2008;143(6):609.
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INTRODUCTION
A 62-year-old man was admitted to the hospital with epigastric pain, nausea, anorexia, and abdominal distention. He had a history of duodenal ulcer with pyloric stenosis 10 years earlier and recent multiple gastric ulcers mainly in the gastric angle. The findings of a physical examination revealed anemia, emaciation, and epigastric tenderness without peritoneal signs. Peripheral blood cell counts and biochemical test results showed anemia (hemoglobin level, 10.9 g/dL [to convert to grams per liter, multiply by 10.0]), nutritional impairment (serum total protein level, 5.7 g/dL [to convert to grams per liter, multiply by 10.0]; albumin level, 3.1 g/dL [to convert to grams per liter, multiply by 10.0]; and total cholesterol level, 112 mg/dL [to convert to millimoles per liter, multiply by 0.0259]), and mild inflammation (C-reactive protein level, 18.1 mg/L [to . . . [Full Text of this Article]
What Is the Diagnosis?
Author Affiliations: Departments of Surgery, The Jikei University School of Medicine, Tokyo (Drs Iida, Hanyu, and Yanaga), and Sasaki Private Hospital, Saitama (Drs Akita and Sasaki), Japan.
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