PMC5906763_01
CT Abdomen Pelvis upon presentation. (a) Marked distention of the stomach with fluid. (b) Pneumobilia involving left lobe of liver. (Arrow pointing).
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Initial EGD 1, 2-Reveal LA grade D esophagitis 6, 7-Reveal large malignant ulcerated mass with stigmata of bleeding in second part of duodenum.
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EGD showed Grade D esophagitis, excessive fluid in stomach and a large ulcerated area in second part of duodenum. (Figure 2) There was a large brown hard object embedded within the ulcer which could be not be removed.
Repeat EGD 1 week later. 3-Reveal LA grade A erosive gastritis 5, 6-Reveal complete resolution of prior duodenal ulcer.
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Repeat EGD a week later showed total resolution of the ulcerated area in the duodenum and a significant improvement in esophagitis to LA Grade A. (Figure 3) EUS revealed peri-pancreatic inflammation and poor visualization of the gallbladder.
Multiple gallstones removed from distal jejunum and proximal ileum through laparoscopic small bowel enterotomy.
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She underwent laparoscopic small bowel enterotomy with removal of gallstones from distal jejunum and proximal ileum. (Figure 4) The patient slowly began eating and was discharged with uneventful post-operative course.