title: 'Kissing' duodenal ulcers.
abstract: Among 70 cases of perforated duodenal ulcers treated by plication, eight were complicated by massive postoperative hemorrhage from a syncronous posterior "kissing" duodenal ulcer. Critical analysis revealed that only signs of gastrointestinal (GI) bleeding preoperatively had predictive value for postoperative hemorrhage. Twenty-four patients had one or more predictive signs, and eight actually bled postoperatively. There was a 50% mortality and 75% additional complication rate for the bleeders. In contrast, the nonbleeders had a mortality and a complication rate of only 18% and 35%, respectively. There was no observed superiority of either surgical or medical treatment for postoperative hemorrhage. In perforated duodenal ulcer with evidence of GI blood loss, an intraoperative search for a posterior kissing ulcer is recommended. If a kissing ulcer is found, an acid-reducing operation and suture ligation of the ulcer is indicated.
mesh_terms: D000368:Aged; D002140:California; D004381:Duodenal Ulcer / Q000150:complications* / Q000401:mortality / Q000601:surgery; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology* / Q000401:mortality; D010439:Peptic Ulcer Perforation / Q000150:complications* / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies