[Duodenal post-bulbar ulcers. Diagnostic and therapeutic problems].
Our study upon 1235 cases of duodenal ulcers (1991 - 2001) revealed a decrease of its morbidity rate of 10 - 12%. However, the incidence of the post-bulbar duodenal ulcer (P.B.D.U.) remained constant - 9,33% (115 cases) from all duodenal ulcers. Its diagnostic and therapeutic difficulties, its peculiar etiology, pathogeny, topography and evolution are the consequence of the duodeno-bilio-pancreatic morphologic modifications, clinic polymorphism, radiologic indirect signs and difficult endoscopic localisation. Definitive diagnosis was set only intraoperatively. There are 2 forms of P.B.D.U.: proximal (D1 fixed) - 62,60% and distal (D2 above duodenal papilla) - 37,40%. Associated bilio-digestive lesions were encountered in 30 cases (26,08%). Due to its aggressive, endocrine-type etiology and pathogeny, evolution to severe complications and resistance to modern medical therapy, the PBDU should be of first surgical intent, considering a radical procedure whenever possible. Gastric 2/3 resection or truncal vagotomy with limited gastric resection were achieved in 90,43% of cases. We preferred the Bilroth II type anastomosis (65,20%) excluding the ulcerous lesion. Drainage of the duodenal stump was employed in 26% of cases. Specific postoperative morbidity of 12,17%, an early re-operations rate of 6,05% and postoperative mortality of 3,47% versus 2,05% for the duodenal ulcers, emphasize the severity of the P.B.D.U.
Ghelase
F
F
Clinica de Chirurgie I, Spitalul Clinic de Urgenţă Craiova, U.M.E Craiova, Dolj. fane35@lycos.com
Georgescu
I
I
Ghelase
St
S
Mărgăritescu
D
D
Sandu
Em
E
Cioară
Fl
F
Cioară
D
D
Bratiloveanu
T
T
D004381:Duodenal Ulcer / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005743:Gastrectomy / Q000379:methods; D005763:Gastroenterostomy; D006801:Humans; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D015167:Vagotomy, Truncal