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 epigastricregion and decreased appetite of 3 months durationunderwent abdominal computed tomography (CT). CT revealedthe 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 tothe liver cyst on CT. Endoscopy revealed an ulcerative lesion inthe gastric angle of the lesser curvature along with a pinholesizedperforation site at the bottom of the gastric ulcer. Serumanti-Helicobacter pylori immunoglobulin G antibody titer was elevated.Based on these findings, the patient was diagnosed withgastric ulcer penetration into the liver cyst. Following endoscopy,the patient complained of tenderness in the epigastric region.Laboratory findings demonstrated an increased white blood cellcount, 20 900/μl and an increased C-reactive protein concentration,19.0mg/dl. Abdominal CT following endoscopy revealed anair-f luid level in the liver cyst, most likely caused by the forced air administered during endoscopy (Fig. 1B). No intraperitonealfree gas or ascites was observed on CT.