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KMID : 0931320080080010049
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대한상부위장관.헬리코박터학회지
2008 Volume.8 No. 1 p.49 ~ p.53
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Duodenal Ulcer Bleeding with Transmural Necrosis after Combined Use of High Dose Steroid and Nonsteroidal Anti-Inflammatory Drug: A Case Report
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Na Youn-Ju
Shim Ki-Nam
Kang Min-Jung
Jung Ji-Min
Ha Chang-Yoon
Jung Hae-Sun
Baik Su-Jung
Kim Seong-Eun
Jung Sung-Ae
Yoo Kwon
Moon Il-Hwan
Koo Hae-Soo
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Abstract
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Non-steroidal anti-inflammatory drug (NSAID) inhibits the cyclooxygenase and the production of prostaglandin in the gastrointestinal mucosa. Direct mucosal injury caused by NSAID results in erosions and active ulcerations in the stomach. Simultaneous use of the NSAID and the high-dose steroid in fact increases the harmful side-effects such as hemorrhage and perforation of peptic ulcer, while the root mechanisms have not been understood well. In this paper, we introduce a case in which a 50-year-old male patient had taken a high dose steroid with NSAIDs for managing the cord compression syndrome after the operation. The patient had black tarry stool with no epigastric pain. Endoscopic findings showed three ulcers with oozing bleeding from the exposed vessel in the bulb of the duodenum and multiple active ulcers in the second portion of the duodenum. After submucosal injection with 8 ml of diluted epinephrine, bleeding in the duodenal bulb was stopped. Eight hours later, the active bleeding recurred from 2nd portion of duodenum, but the bleeding focus couldn’t be found by the second endoscopic examination. An emergency operation was performed due to the uncontrolled bleeding. In pathologic finding, massive transmural hemorrhagic necrosis of the duodenum was observed. Here, we report a rare case of transmural necrosis of the duodenum due to the combined use of NSAID and high dose steroid. (The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2008; 8:49-53)
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KEYWORD
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Steroid, Nonsteroidal anti-inflammatory drug, Necrosis, Duodenum
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