Pediatr Gastroenterol Hepatol Nutr.  2012 Dec;15(4):266-271.

A Case of Small Bowel Ulcer Associated with Helicobacter pylori

• Kim EY
• Kim JH
• Woo SB
• Lee JW
• Lee KH
• Shin SR
• Lee JH

Abstract

The etiology of peptic ulcer disease in children may be primary, associated with Helicobacter pylori infection, or secondary, relied on underlying disease. Ulcerative lesions by H. pylori are mainly distributed in the duodenal bulb and they are rare below the ampulla of Vater because H. pylori growth is inhibited by bile juice. In this reason, there are only some restrictive reports presented small bowel ulcer associated H. pylori. We found multiple small bowel ulcerative lesions associated with H. pylori in an 11-year-old girl without any systemic disease while performing esophagogastroenteroscopy to the level of the proximal jejunum for differentiating bezoar. The abdominal pain improved after the patient was administered H. pylori eradication therapy. Because a small bowel ulcer associated with H. pylori has rarely been reported, we report it here with literature review.

Keyword

Helicobacter pylori; Small bowel; Ulcer; Jejunum

MeSH Terms

Abdominal Pain
Ampulla of Vater
Bezoars
Bile
Child
Helicobacter
Helicobacter pylori
Humans
Jejunum
Peptic Ulcer
Ulcer

Figure

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  Fig. 1 Abdominal computed tomography (CT) scan shows a 4 cm sized low attenuating mass-like lesion in the stomach.

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  Fig. 2 The esophagogastroduodenoscopic findings. (A) Active ulcer lesion (at 60 cm from incisor) covered with whitish exudate at the base and surrounded with erythematous mucosa. (B) Multiple longitudinal ulcerative lesions beyond the second portion of the duodenum.

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  Fig. 3 Abdominal X ray shows two clips indicating the position of the endoscopic approach level.

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  Fig. 4 (A) A shallow focal ulcerative lesion (black arrow) with superficial layers of fibrinoid necrosis, underlying granulation tissue and dense lymphoid infiltration is noted in the proximal jejunum (hematoxylin and eosin [H&E], ×100). (B) Duodenal mucosa shows severe chronic active inflammation with reactive epithelial atypia (H&E, ×200).

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