case_images: PMC5906763_01
case_images: CT Abdomen Pelvis upon presentation. (a) Marked distention of the stomach with fluid. (b) Pneumobilia involving left lobe of liver. (Arrow pointing).
case_images: ZJCH_A_1452517_F0001_PB.jpg
case_images: PMC5906763_01_ZJCH_A_1452517_F0001_PB.jpg
case_images: F0001
case_images: 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.
case_images: ZJCH_A_1452517_F0002_PB.jpg
case_images: PMC5906763_01_ZJCH_A_1452517_F0002_PB.jpg
case_images: F0002
case_images: 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.
case_images: Repeat EGD 1 week later. 3-Reveal LA grade A erosive gastritis 5, 6-Reveal complete resolution of prior duodenal ulcer.
case_images: ZJCH_A_1452517_F0003_PB.jpg
case_images: PMC5906763_01_ZJCH_A_1452517_F0003_PB.jpg
case_images: F0003
case_images: 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.
case_images: Multiple gallstones removed from distal jejunum and proximal ileum through laparoscopic small bowel enterotomy.
case_images: ZJCH_A_1452517_F0004_PB.jpg
case_images: PMC5906763_01_ZJCH_A_1452517_F0004_PB.jpg
case_images: F0004
case_images: 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.