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Postbulbar Duodenal Ulcer
Author(s) -
Ritchie James D.
Publication year - 1976
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1976.tb03212.x
Subject(s) - medicine , barium meal , duodenal bulb , perforation , surgery , complication , duodenal ulcer , duodenoscopy , endoscopy , duodenum , punching , materials science , metallurgy
Postbulbar duodenal ulceration is not common, but when present is difficult to diagnose and treat. Between January 1965 and September 1971, 1,080 patients with duodenal ulcers were treated surgically at St James Hospital. Forty‐one ulcers were found at operation to lie distal to the duodenal bulb. Pain was the most common indication for surgery. In six patients it was clinically indistinguishable from biliary pain, giving rise to diagnostic difficulty. Twelve patients (29%) presented with hæmorrhage, a percentage similar to the 25% of bulbar ulcers presenting with this complication over the period of this study. This is contrary to the finding in most other series, that postbulbar ulceration is more frequently complicated by hemorrhage than is bulbar ulceration. Perforation and stenosis are uncommon complications. Postbulbar ulceration is easily overlooked in conventional barium studies. Only one‐third of the patients subjected to barium meal X‐ray examination had their ulcers identified in the first study. In a further third the presence of an ulcer was suspected, and the remainder required multiple investigations for undiagnosed symptoms before the condition was demonstrated. Duodenoscopy was not performed in a sufficient number of patients for its value to be assessed, but other reports indicate that it should be a valuable manæuvre. The technical difficulties and potential hazards of Pólya gastrectomy are discussed and special reference is made to the surgical management of bleeding postbulbar ulcers.