Post Bulbar Duodenal Ulcer

The above images from a double contrast upper GI study show a filling defect in the post bulbar duodenum with radiating folds (arrow) causing distal narrowing/stricture most consistent with a post bulbar ulcer.

Post bulbar ulcers are rare and constitute about 5% of all duodenal ulcers. There is a higher likelihood of life threatening bleeding with post bulbar ulcers than with ulcers in the first portion of the duodenum. While ulcers of the duodenal bulb are almost always associated with H. pylori infection, the prevalence of H. pylori in post bulbar ulcers is significantly less and post bulbar ulcers should be worked up for malignancy and Zollinger-Ellison syndrome. 


REFERENCES
Carucci LR, Levine MS, Rubesin SE, Laufer I. Upper gastrointestinal tract barium examination of postbulbar duodenal ulcers. AJR Am J Roentgenol 2004;182(4):927-30.
Kaufman SA and Levene G. Postbulbar duodenal ulcer. Radiology 1957;69:848-52.