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Tomonori Iida, MD; Haruyuki Akita, MD, PhD; Masasi Sasaki, MD, PhD; Nobuyoshi Hanyu, MD, PhD; Katsuhiko Yanaga, MD, PhD
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Section Editor: Grace S. Rozycki, MD, MBA

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Arch Surg. 2008;143(6):609. doi:10.1001/archsurg.143.6.609.
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A 62-year-old man was admitted to the hospital with epigastric pain, nausea, anorexia, and abdominal distention. He had a history of duodenal ulcer with pyloric stenosis 10 years earlier and recent multiple gastric ulcers mainly in the gastric angle. The findings of a physical examination revealed anemia, emaciation, and epigastric tenderness without peritoneal signs. Peripheral blood cell counts and biochemical test results showed anemia (hemoglobin level, 10.9 g/dL [to convert to grams per liter, multiply by 10.0]), nutritional impairment (serum total protein level, 5.7 g/dL [to convert to grams per liter, multiply by 10.0]; albumin level, 3.1 g/dL [to convert to grams per liter, multiply by 10.0]; and total cholesterol level, 112 mg/dL [to convert to millimoles per liter, multiply by 0.0259]), and mild inflammation (C-reactive protein level, 18.1 mg/L [to convert to nanomoles per liter, multiply by 9.524]). Gastrointestinal fiberscopy (Figure 1) and barium enema (Figure 2) were performed.

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Figure 1.

Gastrointestinal endoscopy indicated a giant gastric ulcer at the gastric angle. At the bottom of the ulcer, what appears as the intestine with 2 openings (arrows) was identified.

Grahic Jump Location

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Figure 2.

Barium enema showed backward flow of barium from the transverse colon into the stomach (arrows).

Grahic Jump Location

WHAT IS THE DIAGNOSIS?

A. Large peptic ulcer

B. Gastric adenocarcinoma type 2

C. Gastrocolic fistula associated with a gastric ulcer

D. Gastric submucosal tumor

Figures

Place holder to copy figure label and caption
Figure 1.

Gastrointestinal endoscopy indicated a giant gastric ulcer at the gastric angle. At the bottom of the ulcer, what appears as the intestine with 2 openings (arrows) was identified.

Grahic Jump Location
Place holder to copy figure label and caption
Figure 2.

Barium enema showed backward flow of barium from the transverse colon into the stomach (arrows).

Grahic Jump Location

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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