Hemorrhagic duodenal ulcer and subsequent acute appendicitis following lobectomy for lung cancer

A 62-year-old Vietnamese male presented for an elective video-assisted thoracoscopic surgery lobectomy for treatment of a suspicious lung mass. Postoperatively, he developed a hemorrhagic duodenal ulcer requiring endoscopic hemostasis. Interestingly, he subsequently became septic secondary to perforated acute appendicitis necessitating laparoscopic appendectomy. Surgery can evoke a physiological stress response and may be a causative factor in the pathogenesis of stress ulcers in surgical patients. A recent article has found an association between the development of acute appendicitis in patients with a history of peptic ulcer disease. The pathological mechanism responsible for this association may be the result of an imbalance of the autonomic nervous system and neuromusculature spasms at the ceco-appendiceal junction.