Giant gastric ulcer: a challenging diagnosis in the deployed military environment

The purpose of this article is to report on the evaluation of vague abdominal pain and anemia in the deployed military environment resulting in the diagnosis of a giant gastric ulcer. This patient's abdominal pain was initially thought to be attributable to a lower digestive tract process and her anemia was insidious in onset but progressive. A computed tomography examination was obtained. Circumferential gastric wall thickening, more prominent posteriorly with ulceration, adjacent inflammation, and perigastric lymphadenopathy suspicious for a malignancy or a giant gastric ulcer was identified. Referral and medical evacuation to a tertiary care facility out of the deployed setting resulted in an endoscopy showing a giant gastric ulcer with no evidence of malignancy. Prompt evaluation of the patient with the most expeditious radiologic imaging modality available at hand, rather than delayed sequential evaluation, revealed an uncommon finding and conceivably saved this patient's life. Close cooperation among appropriate specialists in the deployed setting resulted in an optimal outcome in a suboptimal environment.