Duodenal Kissing Ulcer (Sealed Anterior Perforated Duodenal Ulcer Combined with Hemorrhagic Posterior Ulcer): Report of a Case

Abstract

Peptic ulcer disease and its complications have long been studied but the coexistence of two major complications in a kissing ulcer is uncommon. We present our experience with this entity and review the related literature. A 27 year old man was suffering from concomitant major complication of duodenal kissing ulcer, huge anterior perforation and uncontrolled posterior bleeding, presenting as hemorrhagic shock to emergency department. The posterior ulcer containing pulsatile bleeding from gastroduodenal artery oversewed and the ruptured anterior ulcer converted to pyloroplasty followed by truncal vagotomy. Presence of anterior perforated duodenal ulcer in a patient of bleeding peptic ulcer is an uncommon presentation that needs a high degree of suspicious for preoperative and intraoperative diagnosis.