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Findings: Upper gastrointestinal series demonstrated a 1 cm irregular ulcer crater in the duodenal bulb on air contrast spot films with patient in the right posterior oblique position. Additional films of the duodenal bulb in the prone position wherein the duodenal bulb was completely filled with barium, showed no evidence of deformity of the duodenal bulb.
Diagnosis: The patient was subsequently taken to endoscopy where an acute duodenal ulcer was diagnosed. Samples for heliobactar pylori were positive. The patient was to be treated with antibiotics.
Discussion: Spot films were obtained which further elicited no evidence of deformity in an upright position. Neither was there evidence of tenderness upon compressing the duodenal bulb. Upon further questioning the patient, it was learned that her lower abdominal pain was relieved after the ingestion of antacids or after she had begun to eat.
References:
Margulis AR, Burhenne HJ. Alimentary Tract Radiology, 3rd Edition, 1983; 800-831.
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