Results of vagotomy in duodenal ulcer not responsive to conservative treatment]

In the article, an analysis of the results of vagotomy with pyloroplasty in 114 patients showing duodenal ulcer is presented. It is concluded that patients with uncomplicated duodenal ulcer and minimum changes in the duodenum should not be subjected to vagotomy, though, as a rule, they have a lot of complaints. In patients with marked ulcerous changes in the duodenum vagotomy yields quite satisfactory late results.     

One-stage segmental pylorus-preserving resection of the stomach and duodenum in stenosing duodenal ulcer]

The analysis of the results of surgical treatment of 32 patients with duodenal ulcer disease complicated by postpyloric stenosis of the duodenum, using the original technique--combination of selective proximal vagotomy with segmental pylorus-preserving resection of the stomach and duodenum was carried out. A good immediate and long-term result was noted, there were no ulcer recurrences. Such an operative intervention is expedient in stenosing duodenal ulcer, its combination with a gastric ulcer, and as well in postvagotomy ulcer recurrency developing against the background of high gastric acid production.     

The surgical procedure in ulcerous duodenal hemorrhages]

Available are the results of treatment of 493 patients with duodenal ulcer complicated by bleeding in the center of gastro-intestinal bleedings at N. I. Pirogov City Hospital No. 1 in 1995-1996 years. 74 patients were operated. Overall lethality made up 1.8%, postoperative lethality rate--8.1%. In ulcer of posterior wall of the duodenum, 10 mm and more in diameter with blood loss of medium and high degree, the number of relapses made up 57.1%. In cases of urgent operations (n = 30); carried out on the first day of admittance to the hospital, 1 patient died. Expectant policy in treatment of patients with ulcer of posterior wall of the duodenum results in poor effect of the treatment and complications (4.1%). The advantages of active individual approach in treatment of patients with acute duodenal bleeding are outlined.     

The choice of the surgical treatment method in gastric and duodenal peptic ulcer]

Operations were carried out on 966 patients for gastric ulcer (GU) and duodenal ulcer (DU); the ages of 78% of them ranged from 31 to 50 years. 241 patients underwent operation for GU. Stenosing ulcer was found in 21.4%, penetrating ulcer in 37.3%, bleeding ulcer in 29%, perforating ulcer in 8.3%, and ulcer-tumor in 3.4% of patients. Resection of the stomach after Billroth I was conducted in 32.2%, pyloric preserving resection in 43.1%, Spasokukotski?-Finsterer operation in 5.7%, and selective proximal vagotomy with excision of the ulcer in 19% of patients. DU was found in 725 patients. The ulcer was stenosing in 42.2%, penetrating in 37%, bleeding in 14.7%, and perforating in 6.1% of patients. The following operative interventions were performed: gastric resection after Spasokukotski?-Finsterer, selective proximal vagotomy and pyloroplasty, selective proximal vagotomy, Billroth I operation, excision of the ulcer and selective proximal vagotomy, stitching of the vessels. The long-term results were good in 94.5% of patients.     

Massive haemorrhage from gastroduodenal ulcer. A series of 149 casees operated on.

A series of 149 patients operated on for massive haemorrhage from gastroduodenal ulcer is presented. The patients were divided into two groups, emergency (70 patients) and semi-emergency (79 patients). In the emergency group the cause of bleeding was GU in 67% and DU in 26%; in the semi-emergency group the corresponding figures were GU 30% and DU 63%. In DU vagotomy + antral resection or pyloroplasty were the usual procedures. GU patients usually underwent a classical resection. The operative mortality rate in the emergency group was 14% and in the semi-emergency group 2.5%. In the whole series the mortality rate was 8.0%. Bleeding recurred in 8 patients (5.4%) and of these eight, five died. The causes of death and the postoperative complications were analysed. In the treatment of massively bleeding duodenal ulcer vagotomy + antral resection is recommended in the case of "good risk" patients and vagotomy + pyloroplasty in the case of "poor risk" patients. For treatment of bleeding gastric ulcer, the procedure recommended with "good risk" patients is still antrectomy, but in cases where the ulcer is situated high up near the cardia and for "poor risk" patients, excision, vagotomy and pyloroplasty should be carried out.     

Status of the emptying function of the stomach in patients with duodenal ulcer after vagotomy with draining operations

Choice of draining operations for treatment of duodenal ulcer by vagotomy is greatly responsible for the evacuatory function of the stomach in the early and remote periods after operation. In patients with stenosis of the duodenum, low localization of ulcer and considerable scarring process in the ulcer area pyloroplasty after Finney and gastroduodenoanastomosis after Jaboulay are considered to be most advantageous draining operations of the stomach. If the operations are not possible technically, shortloop gastrojejunostomy is expedient. Pyloroplasty after Heinicke-Mikulicz is admissible in patients with ulcer of the duodenal bulb in patients with not disturbed evacuation from the stomach.     

In-vitro induced histamine liberation from mucous membrane of the stomach and duodenum before and following vagotomy

In 13 patients suffering from duodenal ulcer and undergoing vagotomy biopsies were taken from mucosa of the gastric fundus and of the duodenum. Histamine release from the samples upon challenge to different food was assayed before and after vagotomy. Generally, more histamine was set free from gastric mucosa than from the duodenal one. However, in 11 of 13 subjects there was an alternative shift in the fundus and in the duodenum after vagotomy.     

Duodenal tuberculosis: A review of the clinicopathologic features and management of twelve cases

A retrospective analysis of twelve cases of duodenal tuberculosis is presented herein. The average age of the patients was 31.4 years with a male to female ratio of 2:1. The presenting complaints were duodenal obstruction in six patients and subacute intestinal obstruction in three. None of the patients had associated pulmonary tuberculosis. Eight patients had isolated duodenal tuberculosis, two of whom were successfully treated with antitubercular drugs. In four patients, the diagnosis was established at laparotomy by the presence of tubercles over the duodenum. Five patients required a bypass procedure for obstruction caused by the duodenal tuberculosis and one patient was operated on for uncontrollable bleeding from a tubercular duodenal ulcer. All patients remained symptom free after treatment, whether medical or surgical. Thus, in areas where tuberculosis is endemic, even in the absence of pulmonary tuberculosis, duodenal tuberculosis should be suspected in patients with upper gastrointestinal obstruction or in patients with peptic ulcer like symptoms not responding to medical therapy     

Duodenal tuberculosis: a review of the clinicopathologic features and management of twelve cases

A retrospective analysis of twelve cases of duodenal tuberculosis is presented herein. The average age of the patients was 31.4 years with a male to female ratio of 2:1. The presenting complaints were duodenal obstruction in six patients and subacute intestinal obstruction in three. None of the patients had associated pulmonary tuberculosis. Eight patients had isolated duodenal tuberculosis, two of whom were successfully treated with antitubercular drugs. In four patients, the diagnosis was established at laparotomy by the presence of tubercles over the duodenum. Five patients required a bypass procedure for obstruction caused by the duodenal tuberculosis and one patient was operated on for uncontrollable bleeding from a tubercular duodenal ulcer. All patients remained symptom free after treatment, whether medical or surgical. Thus, in areas where tuberculosis is endemic, even in the absence of pulmonary tuberculosis, duodenal tuberculosis should be suspected in patients with upper gastrointestinal obstruction or in patients with peptic ulcer like symptoms not responding to medical therapy.     

Endoscopic diagnosis of masked perforated peptic ulcer]

Fifty eight patients hospitalized with a suspicion to masked perforated ulcer of the stomach and duodenum were subjected to urgent fibrogastroduodenoscopy by means of modern endoscopes with fiber optics. In 8 cases the perforation was diagnosed during endoscopy and subsequently supported intraoperatively. In the remaining patients the diagnosis of perforated ulcer was rejected. An application of urgent endoscopy in patients suspected of masked perforated gastric or duodenal ulcer made it possible to avoid useless laparotomies and shorten the terms of preoperative examination and determination of indications to surgical therapy.     

Surgical choices in peptic ulcer associated with duodenal diverticula

The work analyzes surgeon's tactics for associated ulcer disease with duodenal diverticula. Operations were performed on 51 patients with these diseases. The operation of choice is gastric resection after Hofmeister-Finsterer which is sufficiently effective in treatment of ulcer disease and when excluding the duodenum creates conditions for the prevention of inflammation of the diverticulum.     

Plastic filling of bleeding duodenal ulcers in the course of truncal vagotomy with pyloroplasty according Finney

The procedure of plastic filling of bleeding ulcer of the duodenum during vagotomy procedure and pyloroplasty by Finney was developed and used in 26 patients. The study of early postoperative results showed steady hemostasis in all patients and no recurrences of bleeding. Follow-up results up to 3 years were studied in 22 patients. No relapses of ulcer disease were recorded. Thus truncal vagotomy with pyloroplasty by Finney and plastic filling of bleeding ulcer is an effective method for hemostasis and adequate treatment of duodenal ulcer.     

Proteolytic activity of duodenal mucosa in elderly and senile patients in the presence of duodenal hemorrhage from ulcer

During investigation of proteolisis of duodenum mucosa in patients of elderly and senile age with duodenal ulcer, complicated by hemorrhage, in terms up 8 for days there was revealed considerable increase of proteolytic activity, especially of high-molecular proteins and collagens, maximum--on the first day of hemorrhage. In all terms the revealed activity of anterior wall of duodenum was higher, than posterior.     

Double gastroenterostomy tube in gastric surgery.

This report describes a new double gastroenterostomy tube. It has been used in patients where delayed oral feedings are anticipated, ie, a perforated duodenal ulcer, suture-plicated, with stenosis of the duodenum; a duodenal ulcer with outlet obstruction treated with vagotomy and gastroenterostomy; and patients with chronic lung disease undergoing gastric surgery and requiring postoperative respiratory assistance. Its use has proved to be beneficial, and it is cheap and allows early enteric feeding.     

Ten-Year Experience of Managing Giant Duodenal Ulcer Perforations with Triple Tube Ostomy at Tertiary Hospital of North India

Duodenal ulcer perforations have been known since 1600 AD. It is a common surgical emergency and every surgeon will encounter it. The perforation size of >2 cm has been used as the criteria for defining Giant duodenal ulcers. The management of giant duodenal perforations in hemodynamically unstable patient with comorbid condition is taxing because of high incidence of the postoperative leak and mortality. We have used the simple technique of Triple Tube Ostomy after the primary closure of the defect with encouraging results. It is a retrospective study done at the J. N medical college AMU Aligarh from May 2005 to May 2015. Hemodynamically unstable patients who have presented to the emergency with preoperative diagnoses of giant duodenal ulcer perforation and had undergone triple tube ostomy with primary repair of the perforation were included in the study. There were 34 patients of giant duodenal perforation who presented in shock. All of them underwent triple-tube-ostomy after primary repair of the duodenum. Thirty-two patients recovered with two mortalities (5.8 %). Several definite surgical techniques have been described for the management of giant duodenal ulcer perforation but they are complex, have very high morbidity and mortality rate and require an expert surgeon. A close retrospective scrutiny of the patients suggests that simple triple-tube-ostomy technique which is based on the principle of damage control surgery has good postoperative results Therefore, we recommend it as the procedure of choice in these patients.     

Perforated duodenal ulcer associated with an incarcerated hiatal hernia: report of a case

We report the case of a perforated duodenal ulcer and diffuse peritonitis associated with an incarcerated hiatal hernia. A 77-year-old woman with a 17-year history of rheumatoid arthritis treated with nonsteroidal anti-inflammatory drugs, who had also been receiving treatment for non-Hodgkin's lymphoma over 4 years, was referred to us for investigation of nausea and vomiting. An abdominal compute tomography (CT) scan showed an incarcerated hiatal hernia and free air in the hernia sac. Emergency laparotomy revealed an incarcerated hiatal hernia involving the stomach, transverse colon, and omentum. A perforated ulcer was also found in the posterior wall of the first portion of the duodenum. The combination of these disorders is thought to be rare in patients with a hiatal hernia and free air in its sac. As the reported mortality of perforated gastric ulcer associated with a hiatal hernia is high, early elective surgery should be performed in patients with a duodenal ulcer associated with a hiatal hernia. Received: December 25, 2001 / Accepted: May 7, 2002 Reprint requests to: Y. Otsuka     

Pathological features and treatment of ulcerative lesions of the duodenum associated with Crohn's disease

Among a total of 22 patients with Crohn's disease, eight patients with duodenal ulcerative lesions were investigated for pathological features and treatment. All duodenal ulcerative lesions of the eight patients were difficult to be distinguished morphologically from peptic duodenal ulcers at the beginning. But during the course of observation six of eight lesions revealed different pathological features from peptic duodenal ulcers: One showed highly edematous mucosa. Four granular mucosa, and another one longitudinal ulcers and cobblestone appearance. Gastric analysis of these patients showed 6.6 +/- 4.0 mEq/L of BAO and 21.3 +/- 3.4 mEq/L of MAO which was comparable to high acidity of peptic duodenal ulcers. Effectiveness of administration of anti-peptic ulcer drugs only and both anti-peptic ulcer drugs plus drugs against Crohn's disease were 40.0% and 57.1%, respectively. Two patients underwent distal partial gastrectomy. Recurrence was not observed. In conclusion, high acidity would be a cause of duodenal ulcerative lesions associated with Crohn's disease, and the pathological features of them would be affected by Crohn's disease itself. Anti-peptic ulcer drugs should to be administered as well as drugs against Crohn's disease. The method which has hypoacidity effect should be selected in operative therapy to such patients as to have stenosis of the duodenum.     

Villoglandular adenoma of the duodenum.

Two cases of villoglandular adenoma of the duodenum presenting with features of peptic ulcer are reported. At surgery both patients had intussusception of the duodenum. One of them had carcinoma in situ. The literature is briefly reviewed, and the importance of keeping in mind this rather rare condition, even in areas where duodenal ulcer is widely prevalent, is emphasized.     

Endoscopic evaluation of reflux gastritis in patients operated on for stomach and duodenal ulcers

An analysis of results of the endoscopic examination of 320 patients who had been subjected to various operations for ulcer disease of the stomach and duodenum has shown that sphincter-preserving operations (selective proximal vagotomy without drainage of the stomach and pylorus-preserving resection of the stomach) in treatment of ulcer disease of the stomach and duodenum with correction of disturbances of duodenal passability is the most reliable method for prevention of duodeno-gastric reflux and reflux-gastritis.     

Changes in immunologic reactivity in patients with gastrointestinal bleeding]

The disorders in immunologic reactivity in acute gastrointestinal bleeding were studied in dynamics in 160 patients. Pronouncement of disorders in the T-system of immunity, activation of the reactions of specific sensibilization and autoallergic phenomena depend on severity of the blood loss. In ulcer location in the duodenum, the performance of an organ-preserving operation with vagotomy and elimination of the ulcer which is a source of antigen stimulation is preferable.