Double Perforated Kissing Ulcers of Duodenum: A Brief Report

Kissing duodenal ulcer in a young adult presenting as upper gastrointestinal bleeding in a resource-limited setting: A case report and literature review

INTRODUCTION

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.

PRESENTATION OF CASE

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.

DISCUSSION

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.

CONCLUSION

As demonstrated in this index case report, early diagnosis and surgical intervention could be lifesaving in a resource-limited setting.