Marginal ulcer perforation: a single center experience.
OBJECTIVE
Marginal ulcer (MU) is defined as ulcer on the jejunal side of the gastrojejunostomy (GJ) anastomosis. Most MUs are managed medically but those with complications like bleeding or perforation require intervention. It is recommended that GJ anastomosis be revised in patients with MU perforation (MUP). The aim of this case series is to study the clinical presentation and management of MUP.


METHODS
Three hundred and thirty-two patients who underwent emergency surgery for perforated peptic ulcer at a single center were studied over a period of 5 years.


RESULTS
Nine patients (2.7 %) presented with MUP. GJ was previously done for either complicated peptic ulcer (n = 4) or for suspected gastric malignancy (n = 5). Two patients had previously completed H. pylori therapy. None of the patients presented with septic shock. MU was on the jejunal side of GJ in all patients. The median MUP size was 10 mm. Four patients (44.4 %) had omental patch repair, three (33.3 %) had primary closure, and one each had revision of GJ and jejunal serosal patch repair. There were no leaks, intra-abdominal abscess or reoperation and no malignancies.


CONCLUSIONS
MUP patients do not present with septic shock. Omental patch repair or primary closure is sufficient enough. Revision of Billroth-II-GJ into Roux-en-Y-GJ is not mandatory.
Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore. nsureshkhanna2003@yahoo.co.in.|, 481 Yio Chu Kang Road, #03-01, Castle Green, Singapore, 787056, Singapore. nsureshkhanna2003@yahoo.co.in.
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http://orcid.org/0000-0001-7473-5681
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Natarajan
Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
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D
Chua
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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K
Anbalakan
Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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VG
Shelat
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications*; D010439:Peptic Ulcer Perforation / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology
Marginal ulcer; Marginal ulcer perforation