duodenal ulcer

2-3 x more frequent than gastric ulcers; M:F = 3:1
secondary to increased acid in duodenum
predisposed: cortisone, cerebral injury, surgery, COPD
location: bulbar (95%), postbulbar (3-5%)
findings:
- small, round/ovoid/linear ulcer niche
- "kissing ulcers": ulcers opposite from each other
- giant duodenal ulcer >3 cm (rare): high morbidity; may be overlooked by simulating deformed bulb
- "clover-leaf deformity"; "hourglass stenosis" (healed stage)
complications:
- obstruction (5%)
- perforation (<10%): anterior > posterior wall
- penetration (<5%) = sealed perforation
- hemorrhage (15%): melena > hematemesis

Yong H. Hahn, MD - 2 February 1995
Last updated: 1 October 2013