CASE HISTORY

No available notes.

PATHOLOGY

The specimen consists of the proximal portion of the duodenum with the pylorus and the distal 3.5 cm of the stomach, opened along the greater curvature of the stomach. The duodenum shows two " kissing" ulcers, one on the anterior surface (above) and one on the posterior surface (below). They are both oval and the anterior one is about 1.5 cm in its longer diameter, the posterior one about 2cms. The posterior ulcer is deeper and shows a little surround fibrosis. It was adherent to the pancreas on its deep aspect. The anterior ulcer is more acute and has a thin peritoneal floor which had perforated. There is no distinct reaction in the peritoneum around the perforation and at autopsy the tear was plugged by mucus only, so that it appears that the perforation must have occurred immediately before death.