Gastric ulcer penetration into liver: A case presentation
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A 75-year-old man was admitted because of weakness and dizziness. His past medical history included COPD and hypertension. The patient was not receiving steroids on daily basis. He was, however, abusing nonsteroidal anti-inflammatory medication due to right elbow and wrist osteoarthritis. The patient was a former smoker with 50 packs/year smoking history. Physical examination showed a heart rate at 74 beats/min and blood pressure of 150/68 mm Hg.

The abdomen was soft, non-tender. Bowel sounds were hyperactive. Rectal examination revealed no lesions, masses, and blood and was otherwise unremarkable. Liver functions were within normal limits, and GT was a bit deranged to 56 IU/L. Total bilirubin, blood urea, creatinine, sugar, and coagulation parameters were normal. CRP was 17.3mg/dl. Abdominal ultrasound showed a hyperechoic well-defined mass of 2.38 cm in the right lobe of the liver having hemangioma characters, as well as intrahepatic bile duct dilatation. The patient was booked and done a CT scan which revealed a thickened gastric mucosa without free air and fluid. Tumor markers were all of the normal range. The following day an Oesophago-Gastro-Duodenoscopy (OGD) was performed.

It revealed a large ulcerative crypt in the gastric antrum. No active bleeding was present at the time, and the ulcer base was thick making it hard to obtain biopsies due to this, the patient was booked for diagnostic laparoscopy on the next session available. In the operating room, they discovered a giant gastric ulcer 5 × 2 cm which was penetrating into the liver. Conversion to open approach has been done, and wedge resection of the ulcer was performed followed by primary repair. Histological examination of the specimen revealed a benign ulcer without malignancy features. The patient was stable and has been discharged postoperative day 8.