Acute peritonitis caused by gastric insufflation at endoscopy in gastric ulcer penetration into giant cyst of the left hepatic lobe

摘要

An 80-year-old woman with abdominal distention in the epigastric region and decreased appetite of 3 months duration underwent abdominal computed tomography (CT). CT revealed the presence of a giant cyst, 10 cm in size, in the left hepatic lobe (Fig. 1A). Very slight air was noted in the gastric wall attached to the liver cyst on CT. Endoscopy revealed an ulcerative lesion in the gastric angle of the lesser curvature along with a pinhole-sized perforation site at the bottom of the gastric ulcer. Serum anti-Helicobacter pylori immunoglobulin G antibody titer was elevated. Based on these findings, the patient was diagnosed with gastric ulcer penetration into the liver cyst. Following endoscopy, the patient complained of tenderness in the epigastric region. Laboratory findings demonstrated an increased white blood cell count, 20 900/μl and an increased C-reactive protein concentration, 19.0 mg/dl. Abdominal CT following endoscopy revealed an air-fluid level in the liver cyst, most likely caused by the forced air administered during endoscopy (Fig. 1B). No intraperitoneal free gas or ascites was observed on CT.