Gastrojejunal Ulcer Research Articles

Free perforation of gastrojejunal ulcers after gastrectomy

Two cases of free perforation of gastrojejunal ulcers after gastrectomy are described and the relative rarity of this complication is emphasized. The frequent projection of pain to the chest wall simulating acute myocardial infarction should be borne in mind. Simple suture of the perforation results almost invariably in failure and the performance of definitive surgery in the presence of free perforation is preferred.

Effect of intestinal reversal and massive resection on gastric secretion.

INTESTINAL reversal has been used in humans to delay the passage of food and to increase absorption in conditions where a large portion of the intestine has been resected. Massive intestinal resection alone has been shown to increase gastric secretion of acid.^1-5 It is the purpose of this paper to see what effect a reversed jejunal segment has on gastric secretion alone and in combination with 75% intestinal resection. There are several reports in the literature that indicate that intestinal reversal may affect gastric secretion.^6-8Whether an increase or decrease would result is not clear. Hammer and associates⁶have done complete duodenal reversal and have shown that gastrojejunal ulcers occur. He believed this to be secondary to prolonged gastric retention with antral stimulation. On another occasion Hammer et al⁷showed that gastric emptying is prolonged by a 2-inch reversed duodenal segment. Therefore, gastric retention and

Perforation of a gastrojejunal ulcer into the pericardium. Complication of Wermer's disease (Zollinger-Ellison syndrome).

SINCE Zollinger and Ellison first described the syndrome bearing their name¹and consisting of unrelenting peptic ulceration, gastric hyperacidity, and pancreatic islet-cell adenoma or carcinoma, many additional aspects of this disorder have been described.²The syndrome of endocrine adenomatosis (Wermer's disease)³was described in only eight of the 260 patients reviewed by Ellison.² We have recently treated a patient with Wermer's disease (Zollinger-Ellison syndrome) and gastrojejunopericardial fistula in whom the preoperative diagnosis was made and surgical correction attempted. Communication between the pericardial cavity and the gastrointestinal tract is an extremely rare but serious complication of peptic ulceration which is of much interest to clinicians. The report of a single case is prompted by the rarity of this condition as well as its interesting diagnostic and therapeutic aspects. <h3>Report of Case</h3> A 62-year-old Negro man was admitted to the Queens Hospital Center for the third time on

Supra-ampullary carcinoma of the duodenum

A case of supra-ampullary adenocarcinoma of the duodenum is presented which was treated by modified Whipple pancreatoduodenectomy. Technical considerations in the reconstruction of gastrointestinal continuity and some postoperative problems (pancreatic insufficiency and gastrojejunal ulceration) are discussed.

AN INVESTIGATION IN DOGS OF GASTROJEJUNAL ULCERATION SUBSEQUENT TO A NEW METHOD OF DUODENAL STIMULATION.

AN INVESTIGATION IN DOGS OF GASTROJEJUNAL ULCERATION SUBSEQUENT TO A NEW METHOD OF DUODENAL STIMULATION.

Prevention of ulcer after pancreatic surgery

Extensive pancreatic resections for cancer are complicated by gastrojejunal ulceration and hemorrhage in a significant number of survivors. Experimental evidence indicates that an increase in production of gastric acid accounts for these ulcers, rather than a loss of alkaline pancreatic secretions. Hypersecretion of acid is induced by an operative procedure which preserves the pancreatic islets while preventing adequate enzymes from reaching the upper part of the small bowel. This hypersecretion is sharply reduced by gastric antrectomy. The experiments reported herein show that oral pancreatic enzymes can lower or prevent hyperacidity if they are begun immediately after operation, before hyperacidity becomes established. Enzymes also seem more effective after pyloroplasty or antrectomy. These observations support the essential role of pancreatic enzymatic digestion in regulating gastric acidity. In patients undergoing pancreatoduodenectomy, three steps seem important: (1) removal of the gastric antrum, (2) anastomosis of the pancreatic tail to the jejunum, and (3) administration of oral enzymes in the early postoperative period. Clinical experience with thirty-one patients is described, in which two hospital deaths ( 6 1 2 per cent) and no anastomotic ulcers occurred.

The problem of recurrent gastrojejunal ulcer

Two cases of recurrent peptic ulceration following subtotal gastrectomy are presented, both suggesting the diagnosis of Zollinger-Ellison syndrome. This diagnosis was confirmed histologically in the first case and not in the second. A program of surgical therapy is suggested to deal with the problem of the second case in which a clinical picture of Zollinger-Ellison syndrome was presented, but in which no tumor could be identified. We suggest that the surgical attack should be directed against the pancreas rather than the residual stomach, to interrupt the ulcerogenic tendency and provide maximal postoperative state of nutrition.

Surgical treatment of gastrojejunal stomal ulcer

From this study we could tentatively assert that vagotomy alone is as effective as other procedures in curing gastrojejunal stomal ulcer and has the advantages of a lower complication rate, and possibly, a lower mortality rate. However, there are not enough patients in the study to draw definite conclusions. Furthermore, ten to twenty years more of follow-up examinations may drastically change the results. Therefore, in the good risk patient, we are not yet prepared to advise vagotomy alone to the exclusion of other procedures. We do believe strongly that it is indicated in the emergency, poor risk patient.

The treatment of marginal ulcer.

Of the complications which are associated with the surgical treatment of peptic ulcer, marginal ulceration is one of the most serious. This complication is difficult to manage and carries a poor prognosis. The many different methods of treatment which have been and are recommended indicate that many of the problems related to this disorder remain unsolved. In this communication, the experience with marginal ulceration at the University and Veterans Administration Hospitals is reviewed. An attempt has been made to evaluate critically the effectiveness of treatment. <h3>Methods and Results</h3> The case records of about 300 patients seen during the interval 1928 through 1960, in which a diagnosis of marginal, stomal, or gastrojejunal ulceration and/or gastrojejunocolic fistula was recorded, were reviewed by one of us (L. R.). The 151 of these patients who were accepted for inclusion in the study had convincing clinical and x-ray findings confirming the diagnosis, or the diagnosis

Adrenal rest tumor of the liver

A case of a fifty-nine year old man with an adrenal rest tumor found in the liver at autopsy is presented. The patient had a long clinical history of gastric and gastrojejunal ulcer diatheses.

Six to Ten-Year Follow-Up of the Surgical Treatment of Duodenal, Gastric and Gastrojejunal Ulcer

Six to Ten-Year Follow-Up of the Surgical Treatment of Duodenal, Gastric and Gastrojejunal Ulcer

Prognosis when patient develops marginal ulcer after subtotal resection for duodenal ulcer.

Two series of cases form the basis for my discussion of treatment of gastrojejunual ulcer following previously performed gastroenterostomy or partial gastrectomy. The first series consists of 301 cases in which operation for gastrojejunal ulcer was performed at the Mayo Clinic. In 186 of these cases the gastrojejunal ulcer had developed after gastroenterostomy, and in 115 it had followed partial gastrectomy. The mean interval between the previous operation and the definitive operation for gastrojejunal ulcer was 11.2 years for those having previous gastroenterostomy and 3.7 years for those having previous gastric resection. Of the 301 patients, 91% were men and 9% women. A history of hemorrhage from the ulcer, or evidence of it, was found in about half of the cases (149), and perforation into the colon was present in 6.5%. The perforation occurred mostly as a complication of gastrojejunal ulcer after gastroenterostomy, 16 of our 20 cases being in

Vagus Section in the Treatment of Gastrojejunal Ulcer

Vagus Section in the Treatment of Gastrojejunal Ulcer

Peptic ulcer as a surgical problem

1. 1. The evolutionary procedures in the treatment of peptic ulcer are discussed step by step. 2. 2. Intractable ulcer is a surgical problem. The surgical comfort far exceeds any that can be obtained by protracted and repeated attempts at medical treatment. 3. 3. Recurrent obstruction finally must be corrected by surgical measures. 4. 4. Perforation requires surgery and is discussed from the point of view of simple closure versus resection. 5. 5. Massive hemorrhage is a controversial medical and surgical problem. Unbiased cooperation is urged. It is better to err on the side of early surgical relief than protracted medical observation. 6. 6. Vagotomy is discussed as a routine procedure in gastrectomy. Our conclusion is that there are definite values to vagotomy and there is a useful field for its employment. Especially is it useful in patients with poor nutritional values, in low-lying duodenal ulcer, and in patients with high night secretion and high acid values. 7. 7. The treatment of gastrojejunal ulcer associated with gastroenterostomy and gastric resection is discussed and a personal opinion is expressed. Resection in the former and vagotomy in the latter is recommended. 8. 8. Intestinal replacement of a segment of the stomach by either a portion of the colon or small intestine is presented. Its merits and objections are noted. The procedure is not advised in the treatment of duodenal ulcer. 9. 9. Attempts are made to discuss the problem from a practical point of view.

A Five- to Ten-Year Follow-Up Study of the Billroth I and Billroth II (Polya) Operations for Duodenal, Gastric and Gastrojejunal Ulcer and Gastroenterostomy with Vagotomy in the Treatment of Duodenal Ulcer

A Five- to Ten-Year Follow-Up Study of the Billroth I and Billroth II (Polya) Operations for Duodenal, Gastric and Gastrojejunal Ulcer and Gastroenterostomy with Vagotomy in the Treatment of Duodenal Ulcer

Results of the Surgical Treatment of Duodenal, Gastric and Gastrojejunal Ulcer: A Clinic Based on a Five to Ten-Year Follow-up Study

Results of the Surgical Treatment of Duodenal, Gastric and Gastrojejunal Ulcer: A Clinic Based on a Five to Ten-Year Follow-up Study

Recurrent gastrojejunal ulceration and islet-cell carcinoma of the pancreas.

The surgical treatment of the complications of duodenal ulcer produces good results in the majority of patients, for only 2% to 5% of such operations fail to relieve the ulcer symptoms. Furthermore, many of the patients who subsequently develop marginal ulceration may obtain permanent relief by further medical management or additional surgical procedures. However, there remains a small group of patients who have such a propensity to develop peptic ulceration that subtotal gastrectomy with or without vagotomy fails to alter the course of the disease, and in some total gastrectomy has been necessary. The etiologic factors which separate these patients from the usual ulcer patient have not been clearly delineated in the past. Consequently, the reports by Ellison and Zollinger concerning the association of non-insulin-producing islet-cell tumors of the pancreas and recurrent peptic ulceration have stimulated interest in the possible relationship of these two lesions. 1,2 We have recently encountered

Subtotal gastrectomy with and without vagotomy for duodenal and gastrojejunal ulcer; present status.

• Subtotal gastrectomy alone was done in 224 patients and combined with infradiaphragmatic vagotomy in 217 patients who had duodenal and gastrojejunal ulcer. Of the three operative deaths, two were in the latter group but could not be ascribed to the vagotomy. Of the 17 proved instances of recurrent peptic ulcer disease, only one was in the vagotomized group. Vagotomy entailed an increase in postoperative morbidity and a risk of prolonged moderate diarrhea, but it afforded some protection against subsequent jejunal ulceration. Gastroenterostomy was done in 101 patients, with vagotomy in 70 of these. The rate of recurrences was 15 % in the patients without and 10 % in the patients with the vagotomy. It appeared that vagotomy afforded little protection to the patients with gastroenterostomy. A continuation of the subtotal gastrectomy of the Billroth 2 type, preferably combined with vagotomy, is recommended on the basis of this experience.

The surgical treatment of gastrojejunal ulceration.

The first use of in the treatment of gastrojejunal ulcer at the Mayo Clinic was in 1945. In the years 1945 to 1952 inclusive, 617 operations were performed on 586 patients for gastrojejunal ulcer. One hundred and forty-three of these operations consisted of alone or of combined with additional procedures, while 474 were operations in which was not done. The latter operations consisted primarily of gastric resection. The 143 patients who underwent will be called the vagotomy group. A group of 158 patients treated for gastrojejunal ulcer by gastric or gastric re-resection during the same interval was studied also and this will be referred to as the resection group. * The 301 cases included in this study were divided into two groups: 115 cases in which gastrojejunal ulcer occurred after gastric resection, and 186 cases in which gastrojejunal ulcer occurred after gastroenterostomy. By analyzing these

The Role of the Pyloric Antrum in the Production of Gastrojejunal Ulcer Following Gastrectomy

The Role of the Pyloric Antrum in the Production of Gastrojejunal Ulcer Following Gastrectomy