SUBACUTE ULCER OF STOMACH
An ulcer in the transitional stage between acute and chronic has been termed subacute ulcer. Morphologically, it differs in degree from an acute ulcer insofar as it is more rounded and has a greater depth. Its walls are thicker and higher, and its shape is occasionally funnel-like, with irregular contours. The subacute phase of a peptic ulcer has involved both the mucosa and submucosa, but at times it may reach the muscular coat. In any event, the subacute ulcer may have the same potential danger for perforation or profuse bleeding as does an acute or a chronic ulcer. At the floor of the ulcer, one finds purulent, grayish-yellow, necrotic material. The grayish-white color on the floor or edges may be due also to proliferating fibroblasts, as a token of a healing tendency and the beginning of scar formation.
Only one
subacute ulcer is usually present. If multiple subacute ulcers are present,
they are larger than single or multiple acute ulcers, though, as a rule,
smaller than a fully developed chronic lesion would be.
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| Plate 4-44 |
The concept
of the subacute ulcer is derived essentially from observations of the
pathologist. In view of the enormous variability in the size, shape, depth, and
other features characteristic of any transitional stage or form of the
pathologic process, the term cannot be sharply defined. Clinically, it is
almost impossible to commit oneself definitely to the diagnosis of subacute
ulcer, except occasionally, when the duration of the patient’s history and
the shallowness of the ulcer, if identified radiologically, may justify the
diagnostic use of this term. The symptoms of subacute ulcer are the same as
those of an acute or a chronic ulcer. In addition, a subacute ulcer may run a
symptom-free course for an indefinite period of time, and its presence may
become evident only after a sudden massive hemorrhage or after the dramatic signs
of acute perforation or the less dramatic ones of “chronic perforation.”
On the x-ray
screen or film, a subacute ulcer is usually demonstrable at or near the lesser
curvature. The niche is, as a rule, clearly outlined and sharply
delimited from the contour of the curvature. It is a fixed deformity, remaining
stationary during the radiologic study, in contrast to the greater part of the
lesser curvature, which participates freely in the peristaltic activity. When
the wall of the ulcer is edematous, the apparent depth may be exaggerated.
