| Duodenal Ulcer Bleeding with Transmural Necrosis after Combined Use of High Dose Steroid and Nonsteroidal Anti-Inflammatory Drug: A Case Report |
| 고용량의 스테로이드와 비스테로이드성 소염진통제 병합 사용 후 발생한 전 층의 괴사를 동반한 십이지장 궤양 출혈 1예 |
|
나윤주ㆍ심기남ㆍ강민정ㆍ정지민ㆍ하창윤ㆍ정해선ㆍ백수정ㆍ김성은ㆍ정성애ㆍ유 권ㆍ문일환ㆍ구혜수* |
|
이화여자대학교 의학전문대학원 내과학교실, 병리과학교실*,의과학연구소 |
|
|
| Abstract |
|
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) |
| Key Words:
Steroid, Nonsteroidal anti-inflammatory drug, Necrosis, Duodenum |
|
PDF Links
Full text via DOI
Download Citation
