ULTRASOUND DIAGNOSIS OF DUODENAL ULCER IN A PEDIATRIC CASE

CASE DETAILS : -

A 13 yrs old child with h/o chr pain upper abd , occasional vomiting , & had one episode of malena  , was referred for ultrasound . The case was evaluated with ultrasound with fasting status & allowed to sip some water to make upper GI window . The solid organs were normal . No small bowel dilatation was seen . The GEJ & stomach were also normal in mucosal pattern & appearance . The duodenal evaluation showed eccentric focal mural hypoechoic thickening ( 6 mm) in about15 to 20 mm circumferential area in its proximal part . There was a classical mucosal defect or focal depression noted in this region resembling an ulcer crater , harbouring specks of air foci in it ( fig 1). The lesion was constantly persistent on imaging  . Focal luminal & mural / mucosal distortion was also observed ( fig 1 ) . Multiple episodes of hyper duodeno-gastric regurgitation of fluid were also noted during real time scan . So on the basis of classical ultrasound findings a diagnosis of duodenal ulcer was made , which was subsequently confirmed on endoscopy ( fig 2 )

Fig 1- Epigastric midline slightly oblique US scan showing focal duodenal eccentric hypoechoic mural thickening encasing a classical depressive lesion s/o ulcer ( arrows)

Fig 2- Upper GI endoscopic images showing classical duodenal ulcer in frontal & profile views .

Fig 3- Collage showing US & Endoscopic images to highlight identical appearance of duodenal ulcer . 

PS - Endoscopic f/up : Dr S Bohra , Apollo Hospital , Ahmedabad .