Abstract

To the Editor:

A 35-year-old woman presented to our surgical emergency ward with symptoms of peritonitis. Her routine laboratory investigations were in normal range. There was no history of organ transplantation or prescribed immunosuppressant drugs or steroids. An emergency exploratory laparotomy was performed, which revealed a 4-cm perforation in the antral region with a hard base and grayish exudates. To rule out the possibility of a malignant ulcer, Bilroth II gastrectomy was performed. Microscopic examination of the resected specimen showed broad, aseptate hyphae with irregular walls, and frequent perpendicular branching in the exudation and in the lamina muscularis. Resected margins were clear of fungal hyphae. Blood vessel invasion was not detectable. Stain for Helicobacter pylori was negative. The postoperative period was uneventful. Antifungal drugs were not administered because of the clear resected margins and the immunocompetent status of the patient. Subsequent upper gastrointestinal (GI) endoscopy performed at regular intervals (at 3 weeks, at 3 months, then every 6 months) did not reveal any abnormality in the follow-up period of 18 months.