Duodenal ulcer penetration into the liver at the previous left hemihepatectomy site
A 69-year-old man presented to the emergency room with sudden-onset abdominal pain and nausea. He had previously undergone a hybrid laparoscopic left hemihepatectomy and splenectomy for hepatolithiasis and spherocytosis approximately 20 months earlier. Since his surgery, he had occasionally taken non-steroidal anti-inflammatory drugs (NSAIDs), loxoprofen as per his prescription. During the 3 months before his current presentation, he had discontinued taking proton pump inhibitors, at his request.\nAbdominal computed tomography images revealed a deformity of the duodenal bulb and a markedly dilated stomach, containing food residue (); free air in the abdominal cavity was not detected. A fibroscopic upper gastrointestinal examination revealed a giant ulcer with a prominent crater in the inferior wall of the bulb. In addition, a foreign body was detected at the ulcer floor and was strongly suspected of being a ligature associated with the previous left hemihepatectomy (). The foreign body was eliminated, and an endoscopic biopsy was performed. Histopathological examination of the biopsy showed a simple, active ulcer. The patient received conservative therapy with a proton pump inhibitor and recovered immediately.