25585              STOMACH WITH TWO LARGE PEPTIC ULCERS, ONE PERFORATED

The patient was a diabetic woman aged 87 maintained on insulin.  The disease had begun in middle age and she had had bilateral below-knee amputations, a cholecystectomy and appendicectomy, and had congestive cardiac failure.  The recent history was of only 2 weeks loss of appetite, nausea and vomiting.  On the morning of admission she had vomited bright red blood and was in hypovolaemic shock with a BP of 80/40.  Although the BP rose to 145/95, she died shortly afterwards.

The specimen consists of the stomach together with the first portion of the duodenum.  A large oval ulcer is present on the greater curvature.  It measures 9 x 5.5 cms and has a regular rolled edge and a base covered with necrotic slough.  A section for histology has been taken from one portion.  The reverse of the specimen shows the gastro-epiploic artery lying in the base of the ulcer, and a bleeding point is visible as a small protruberance in the base of this large ulcer.  High up on the lesser curvature there is a second ulcer measuring 7 x 5 cms.  It has a somewhat serpiginous but regular border, and there is a perforation measuring 1 cm in length in the centre of the ulcer.  The remainder of the stomach shows some mucosal atrophy, but no other changes.  The duodenum appears normal.