PEPTIC ULCER OF THE TERMINAL OESOPHAGUS, 23033
23033 PEPTIC ULCER OF THE TERMINAL OESOPHAGUS
The patient was a man aged 41. Three years previously he was found to have a hiatus hernia with peptic oesophagitis and stricture. On his last admission there was a history of haematemesis and melaena. He was a very heavy drinker and had been taking large amount of analgesics (paracetamol). The haemoglobin was 6.4 g. The liver was palpable 3 fingers below the costal margin and there was ascites. On the day after admission partial gastrectomy was performed to remove a bleeding benign chronic gastric ulcer 3 cms in diameter high on the lesser curvature. After the operation the wound became infected and he died of pneumonia a week later.
The specimen consists of the lower 14 cms of the oesophagus and the cardiac end of the stomach. There is fibrosis and marked muscular hypertrophy in the terminal 3 cms of the oesophagus. The lumen is considerably reduced and a scarred healed peptic ulcer 1.5 cm in diameter is present. There is some dilatation with congestion and patchy leukoplakia of the oesophagus above the stricture. There is a small (5 mm) acute superficial ulcer with surrounding muscosal congestion just below the cardio-oesophageal junction. The mucosa of the gastric remnant is congested and swollen.