GASTRIC-ULCER PERFORATION INTO THE HEART

Penetration of the pericardium and heart is a very rare complication o f benign peptic ulcer, The case is reported here of a 76-year-old woma n with advanced senile dementia, who was admitted due to melena, Endos copy revealed a large gastric ulcer located in a giant hiatal hernia, The ulcer base was protruding and strongly pulsatile, and seemed to be mobile and free in relation to the ulcer margins, This effect was par ticularly obvious during the pulsatile movements, Endoscopic findings suggested ulcer perforation to the pericardium. The patient's relative s denied consent to surgery, She was therefore treated with conservati ve measures, including parenteral nutrition, ranitidine, and antibioti cs, The patient remained in a relatively stable condition, and she was discharged three weeks later, One month later, however, she was admit ted with massive bleeding and hypovolemic shock, In spite of resuscita tion measures, she died, The autopsy study showed a gastric ulcer pene trating through the pericardium and myocardium into the left ventricle .