22974              CHRONIC PYLORIC AND DUODENAL PEPTIC ULCERS

The patient was a man aged 82 who was admitted with a 3 week history of epigastric pain and melaena.  A duodenal ulcer had perforated some time previously and had been oversewn.  Gastroscopy now suggested benign pyloric stenosis and surgery was planned.  However he developed congestive cardiac failure after intravenous infusion, and did not respond to diuretics.  He died after a month in hospital.  At postmortem ad old anterior myocardial infarct was present and there was bilateral posterior basal pneumonia.

The specimen consists of the stomach and duodenum.  The stomach is greatly dilated and there is an extensive chronic ulcer with irregular overhanging edges at the pylorus, extending into the first part of the duodenum.  Considerable organic pyloric obstruction has resulted.  The ulcer measures 5 cms in length and 3 cms in width, and its base penetrates the head of the pancreas.  A second chronic peptic ulcer 1.5 cm in diameter is present on is deeply excavated and has thickened nodular edges.  There is marked chronic gastritis of the remaining pyloric mucosa and there is less marked chronic gastritis with some mucinous exudation in the body and fundus.  The muscle coat of the pylorus is hypertrophied.