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.

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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.