Ultrasonographic findings of perforated duodenal ulcer

To evaluate the efficacy of ultrasonography in patients with equivocal (or uncertain) clinical findings of perforated duodenal ulcer. Ultrasonography of eight patients with clinically suspected perforated duodenal ulcer but no free gas shadow seen on simple abdomen film was prospectively evaluated and compared with the findings of fifty normal patients. The distance were measured between: 1) the left lobe of the liver and the duodenum (hepatoduodenal interface, HDI). 2) the posterior margin of the duodenum and the anterior margin of the pancreas (pancreaticoduodenal interface, PDI). The echo-pattern of each interface was also evaluated, and the relationship between echo-pattern and each interface or distance was analyzed in addition to the assessment of statistical significance. In the normal subjects (n=50), HDI and PDI echos were asymmetrical, homogeneously curvilinear echogenicity, and the average distance of HDI, PDI and HPD was 2.60 1.00 mm, 2.62 0.70 mm and 10.10 3.48 mm, respectively. However, in 8 patients with perforated duodenal ulcer, HDI PDI was seen as asymmetrically inhomogenous, thickened hyperechogenicity just like two crosstie under railroad, and the average distance of HDI, PDI and HPD was 9.38 3.28 mm, 7.38 2.03 mm and 24.12 4.35 mm. There was a statistically significant difference (p<0.0001) in HDI, PDI and HPD of two groups, the normal group and patient group with perforated duodenal ulcer. Ultrasonographic findings of patients with perforated duodenal ulcer include symmetrically inhomogenous, thickened hyperechogenicity in addition to the wider hepatopancreatic distance.