Wei ML, Tan QL. Chronic ulcer diagnosis and perforation risk with oral agent contrast-enhanced ultrasound: A case report and review of literature. World J Gastroenterol 2026; 32(24): 119006 [DOI: 10.3748/wjg.v32.i24.119006]
Corresponding Author of This Article
Man-Li Wei, Associate Chief Physician, Department of Ultrasound Medicine, The First People’s Hospital of Nanning, The Fifth Affiliated Hospital of Guangxi Medical University, No. 89 Qixing Road, Qingxiu District, Nanning 530021, Guangxi Zhuang Autonomous Region, China. 260077529@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
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case-report
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Wei ML, Tan QL. Chronic ulcer diagnosis and perforation risk with oral agent contrast-enhanced ultrasound: A case report and review of literature. World J Gastroenterol 2026; 32(24): 119006 [DOI: 10.3748/wjg.v32.i24.119006]
World J Gastroenterol. Jun 28, 2026; 32(24): 119006 Published online Jun 28, 2026. doi: 10.3748/wjg.v32.i24.119006
Chronic ulcer diagnosis and perforation risk with oral agent contrast-enhanced ultrasound: A case report and review of literature
Qing-Lan Tan, Man-Li Wei
Man-Li Wei, Qing-Lan Tan, Department of Ultrasound Medicine, The First People’s Hospital of Nanning, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Wei ML collected clinical information and drafted the initial manuscript; Tan QL critically revised the manuscript for key content; both authors have read and approved the final version to be published.
Supported by Youth Fund for Self-Financed Scientific Research Projects of the Guangxi Zhuang Autonomous Region Health Commission, No. Z20190921.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Man-Li Wei, Associate Chief Physician, Department of Ultrasound Medicine, The First People’s Hospital of Nanning, The Fifth Affiliated Hospital of Guangxi Medical University, No. 89 Qixing Road, Qingxiu District, Nanning 530021, Guangxi Zhuang Autonomous Region, China. 260077529@qq.com
Received: January 29, 2026 Revised: February 27, 2026 Accepted: March 18, 2026 Published online: June 28, 2026 Processing time: 132 Days and 8.1 Hours
Abstract
BACKGROUND
Gastric ulcer (GU) perforation is an acute condition with a high mortality rate, typically requiring emergency surgical intervention. Early warning of perforation risk before it occurs would enable earlier and more aggressive intervention. This case report describes a patient undergoing comprehensive treatment for hepatocellular carcinoma (HCC) who developed a chronic GU. Endoscopy and computed tomography (CT) scans failed to determine ulcer depth due to blood crust coverage and gastric wall edema. Oral agent contrast-enhanced ultrasound (OA-CEUS) visualized full-thickness involvement of the chronic ulcer and predicted perforation risk.
CASE SUMMARY
A 47-year-old male patient presented to our hospital for the next course of comprehensive treatment for HCC. He had previously received anti-Helicobacter pylori therapy. Gastroscopy prior to liver cancer treatment revealed chronic non-atrophic gastritis with erosion. During treatment, the patient experienced one episode of bloody stool and self-administered oral medication. Subsequent gastroscopy revealed multiple ulcers attached with necrotic tissue and coffee-ground material, surrounded by edematous mucosa. The diagnosis was compound ulcer (A1-H1 stage, radiation-associated gastroenteritis), and treatment included spraying sucralfate during gastroscopy and oral administration of omeprazole. Abdominal CT did not reveal GU. OA-CEUS demonstrated irregular gastric wall thickening with ulcers extending to the serosal layer at their deepest point, filled with hyperechoic material, indicating perforation risk. Due to negative fecal occult blood test results, the patient requested to continue oral treatment with lenvatinib plus omeprazole. Two weeks later, sudden abdominal pain led to surgical intervention, where acute GU perforation with acute diffuse peritonitis was diagnosed intraoperatively.
CONCLUSION
OA-CEUS can serve as an effective monitoring tool for GU complications during comprehensive treatment of HCC, aiding in the early warning of perforation.
Core Tip: Gastric perforation is a rare yet severe complication of abdominal radiotherapy, occurring more frequently when combined immunotherapy and tyrosine kinase inhibitor therapy are administered. Most patients require emergency surgical intervention. This study reports a case where, within the complex context of comprehensive hepatocellular carcinoma treatment (involving radiotherapy, chemotherapy, immunotherapy, and targeted therapy), traditional methods (gastroscopy, contrast-enhanced computed tomography) could not accurately assess ulcer infiltration depth due to blood crust coverage and gastric wall edema. Oral agent contrast-enhanced ultrasound as a novel monitoring tool, clearly demonstrated that the ulcer had reached the serosal layer, thereby successfully predicting impending perforation.
