Helicobacter pylori eradication in complicated peptic ulcer: Beneficial in most?

Management of gastric outlet obstruction: Focusing on endoscopic approach

Gastric outlet obstruction (GOO) is a medical condition characterized by epigastric pain and postprandial vomiting due to mechanical obstruction. The obstructions typically involved in GOO can be benign or malignant. Peptic ulcer disease is the most common cause of benign GOO, and malignant causes include gastric cancer, lymphoma, and gastrointestinal stromal tumor. With the eradication of Helicobacter pylori (H. pylori) and the use of proton pump inhibitors, the predominant causes have changed from benign to malignant diseases. Treatment of GOO depends on the underlying cause: Proton pump inhibitors, H. pylori eradication, endoscopic treatments including balloon dilatation or the placement of self-expandable stents, or surgery.

Concomitant fungal peritonitis and high ascitic amylase as a rare manifestation of gastric perforation

High ascitic amylase concentration has been reported to be a characteristic of pancreatic ascites. However, values greater than 2000 U/l can also be seen in intestinal perforation. Fungal peritonitis is a serious entity that could also be caused by hollow viscous perforation. Herein we report a 22-year-old woman with epigastric pain, imitating an acute pancreatitis, and abdominal distention. Laboratory and radiological investigations revealed a high ascitic Amylase level with secondary fungal peritonitis due to gastric ulcer perforation. This case highlights the importance of careful clinical evaluation and a multi-disciplines approach in patients with high ascitic Amylase levels especially in limited-resources areas in order not to miss a diagnosis in which a surgical approach can be lifesaving. To the best of our knowledge, this is the first reported case of concomitant very high ascetic Amylase level and fungal peritonitis as a manifestation of gastric perforation.