RESUMEN
Liver penetration is a rare but serious complication of peptic ulcer disease. We report a case of a 33-year-old woman who took large doses of nonsteroidal antiinflammatory drugs and developed a giant duodenal ulcer that penetrated into her liver. The diagnosis was based on histologic examination of endoscopic biopsies. She was initially treated with a proton pump inhibitor, but, within 5 weeks, she developed a symptomatic postbulbar stricture that required surgical correction. We also review 11 other reported cases of endoscopically and histologically diagnosed peptic ulcer penetration into the liver.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas , Diclofenaco/efectos adversos , Úlcera Duodenal/inducido químicamente , Desplazamiento del Disco Intervertebral/tratamiento farmacológico , Úlcera Péptica Perforada/inducido químicamente , Adulto , Antiinflamatorios no Esteroideos/administración & dosificación , Diclofenaco/administración & dosificación , Úlcera Duodenal/patología , Úlcera Duodenal/cirugía , Duodenoscopía , Duodeno/patología , Femenino , Humanos , Técnicas para Inmunoenzimas , Queratinas/análisis , Hígado/patología , Hepatopatías/patología , Hepatopatías/cirugía , Pruebas de Función Hepática , Úlcera Péptica Hemorrágica/inducido químicamente , Úlcera Péptica Hemorrágica/patología , Úlcera Péptica Hemorrágica/cirugía , Úlcera Péptica Perforada/patología , Úlcera Péptica Perforada/cirugíaRESUMEN
The aim of this study was to assess the accuracy of double-contrast magnetic resonance imaging (MRI) with rectal application of the superparamagnetic iron oxide contrast agent (SPIO) ferristene and IV gadodiamide for preoperative staging of rectal cancer. In a randomized phase II dose-ranging trial, 113 patients were studied preoperatively with one of four different formulations of ferristene (Abdoscan) as an enema before MRI. T1-weighted spin-echo (T1w SE) and T2w turbo spin-echo (TSE) single-contrast images were obtained as well as T1w SE and gradient-echo (GRE) double-contrast images after IV gadodiamide injection (Omniscan). Images were assessed qualitatively, and TNM tumor stage was compared with histopathology. High-viscosity ferristene formulations were superior to low-viscosity formulations in tumor staging (accuracy 90% vs 74%, P < 0.01). There was no significant difference between high and low iron content ferristene. MRI had a sensitivity of 97%, specificity of 50%, and accuracy of 82% for staging of rectal carcinoma higher than T2 stage. At receiver operator characteristic (ROC) analysis, MR differentiation between T1/T2 and T3/T4 tumor stages yielded a ROC index of 0.848. Double-contrast MRI is an accurate method for preoperative staging of rectal cancer.