Complicated postbulbar duodenal ulcer: the characteristics of its diagnosis and surgical technic and management

The paper reports on the authors experience used on 90 patient with complicated postbulbar ulcers (10% of the duodenal ulcers) with hemorrhage (23 cases), perforation (7 cases), duodenal stenosis (19 cases) and penetration pancreatic hepato-biliary (41 cases) period 1987-1996. The frequency of hemorrhagic complication was of 25%. As the hemorrhage due to postbulbar ulcer is favoured by vascular fistula, the sever character of the hemorrhage and the frequency of the recurrence, mainly the cataclysmic one, impose the radical surgery as early as possible. The following were used: large Reichel-Polya's gastrectomy (13 cases) Pean's gastro-duodenectomy + vagotomy (9 cases), gastrectomy for exclusion with hemostasis "in situ" and ligature of gastroduodenal artery + vagotomy (7 case). In 7 cases with perforation: Reichel-Polya's gastrectomy in 2 patients, Pean's gastrectomy in 2 cases, excision pyloroplasty (Judd) and vagotomy (3 cases). In the postbulbar ulcers penetrating into the pancreas or into hepatic pedicle the following were performed: Reichel-Polya's gastrectomy (8 cases), Pean's gastrectomy (11 cases of which 8 with vagotomy) gastrectomy for exclusion of ulcer in 22 cases of which 20 with vagotomy. In 14 patients with stenosed ulcers, Reichel-Polya's gastric resection (4 cases), Pean's gastrectomy (8 cases), gastrectomy for exclusion (7 cases). The conclusions may be drawn that the postbulbar ulcers are complicated ulcers that require differential surgical treatment, as early as possible for diminishing the postsurgical morbidity and mortality (6.6% mortality).