Localized duodenal lymphoma masquerading as a duodenal ulcer

A 64-year-old woman presented with atypical abdominal pain, weight loss, melena and hematemesis. Reactivation of a peptic ulcer was diagnosed and she was treated with antacids and cimetidine. When her symptoms recurred 4 months later, a perforated duodenal ulcer was noted on roentgenograms. At laparotomy this proved to be a perforated, localized lymphoma of the duodenum. This case highlights an important consideration in the management of duodenal ulcers. Patients who present with a previously diagnosed peptic ulcer, who demonstrate atypical symptoms and remain refractory to treatment should undergo endoscopic examination and biopsy to rule out an occult localized duodenal lymphoma.