Postbulbar Duodenal Ulcer Research Articles

Surgical management of acute hemorrhagic postbulbar duodenal ulcer after a previous major surgical procedure.

The choice of operation for acute hemorrhagic postbulbar duodenal ulcer after an operation is discussed. Distal partial gastrectomy was performed in six patients. The ulcer was treated by resection, suture, or removal by mucoclasis. Hemostasis was attained in five patients. In another, multiple ulcers were observed in the descending portion of the duodenum and gastrectomy failed to control hemorrhage, resulting in death. Rebleeding was observed in two, one from a newly formed ulcer in the upper part of the papilla of Vater after gastrectomy with truncal vagotomy and which was halted by suture of the ulcer and another was from a newly formed ulcer in the remnant stomach after gastrectomy and which was halted by selective vagotomy and ligation of the left gastric artery. It is recommendable to perform a subtotal gastrectomy and vagotomy combined with removal of the ulcer by mucoclasis or ulcer suture. In some cases, pancreatoduodenectomy may have to be done.

Radiological manifestations of radiation-induced injury to the normal upper gastrointestinal tract.

Radiation-induced injury to the normal esophagus, stomach, and duodenum in patients with advanced cervical carcinoma who received high para-aortic lymph-node irradiation to an average tumor dose of 5,000 rads is discussed. Radiation esophagitis is usually the result of mediastinal irradiation for bronchogenic carcinoma. The most consistent radiological finding is abnormal motility, with esophageal stricture and/or ulceration occurrring less frequently. Radiation gastritis usually presents as pyloric ulceration or irregular contractions of the antrum, simulating gastric carcinoma. Postbulbar duodenal mucosal thickening, ulceration, and strictures may occur. Pertinent clinical features, pathogenesis, and pathological correlations are discussed.

Postbulbar duodenal ulcer and ring-stricture. Cause and effect.

A longitudinal study including repeated hypotonic duodenography examinations was performed on 12 patients with ring-stricture of the descending duodenum. Findings included a common clinical pattern of years of undiagnosed symptoms despite multiple upper gastrointestinal examinations and a characteristic progression of a descending duodenal ulcer to a fixed 2–3 mm stricture diagnosed only by hypotonic duodenography. Surgical proof was obtained only when the duodenum was opened, palpated, and inspected visually from within. Such strictures are not congenital but indicate peptic ulcer disease; they are usually undiagnosed. If suspected, hypotonic duodenography is indicated.

X-Ray diagnosis of postbulbar duodenal ulcer by means of double air contrast method

1. There was done a case report of postbulbar duodenal ulcer of a teenager, which was recently found in our University Hospital. 2. The double air contrast method is suggested to be most useful for discovery of postbulbar duodenal ulcer. 3. The lesions, seen for the last ten years in our country, were summarized and investigated.

Surgical management of postbulbar duodenal ulcers

Surgical management of postbulbar duodenal ulcers

TWO CASES OF FATTY PANCREATIC NECROSIS ASSOCIATED WITH POST-BULBAR DUODENAL ULCER.

Acute pancreatitis may present in various clinical manifestations varying from a comparatively mild pancreatic oedema to severe haemorrhage and necrosis of the organ. Where there is acute inflammatory oedema, the fluid from the pancreatic ducts penetrates into the interstitial tissue accumulating under the pancreatic capsule and spreading into the retroperitoneum. The penetrating pancreatic fluid contains several enzymes. The hydrolysis of neutral fats due to the action of lipase may give rise to fatty necrosis of the pancreas. Among the many possible causes of acute pancreatic necrosis metabolic, toxic, vascular and mechanical factors have been variously mentioned. It is generally accepted that the main cause of pancreatic necrosis is due to the inability of the pancreatic juice to find a satisfactory exit. During the last two years we have observed two cases of fatty necrosis of the pancreas. Experience gained from the first case was of assistance in reaching a correct radiological diagnosis in the second case. Male, aged 71, was admitted to the surgical clinic because of gastrointestinal bleeding, i.e. haematemesis and tarry stools. The general condition of the patient was poor, pulse very weak, RBC 2,140,000; WBC 8,700; blood amylase 128; urine amylase 512 Wolgemuth units. It is our custom to carry out emergency radiography in all cases of acute bleeding from the gastrointestinal tract. The patient was examined only in the supine position. There were no changes in the oesophagus and stomach.

MEGABULBUS OF THE DUODENUM IN THE ADULT. REPORT OF A CASE ASSOCIATED WITH ANNULAR PANCREAS AND ULCERATION.

Megabulbus of the duodenum may be a part of generalized megaduodenum or may be a localized condition. The latter, as presented in the case herein described, is the rarer type and is usually a result of stenosing postbulbar duodenal ulcer, obstructing band, or annular pancreas. Duodenal ulceration is a common complication. The likelihood of identifying the triad of megabulbus, annular pancreas, and duodenal ulcer is stressed.

PORTAL HYPERTENSION FROM POSTBULBAR DUODENAL ULCER.

Introduction Postbulbar duodenal ulcers comprise about 5% to 10% of all duodenal ulcers. 1-6 These lesions have a greater tendency to bleed massively, often are deeply penetrating, and frequently require surgical therapy. More uncommon complications of this ulcer are duodenal obstruction and obstruction of the common bile duct. Because of their location in the second portion of the duodenum, visualization on upper gastrointestinal series is often difficult. We have recently had the opportunity to observe two patients who had extrahepatic portal vein obstruction and portal hypertension resulting from this disease. The portal vein was occluded by massive periduodenal scarring and inflammation. Although many causes for extrahepatic vein obstruction have been noted, postbulbar duodenal ulcer has not been reported even as a cause. 7 Because of the problems encountered in differential diagnosis, these cases will be reported in detail. Case 1. —This 68-year-old white male was admitted Jan 12, 1959, with

Post-bulbar duodenal ulceration in Ngeria.

In Southern Nigeria there is a very high incidence of post-bulbar duodenal ulcers. These often present with a typical intermittent history of abdominal pain frequently referred to the back and episodes of haematemesis or melaena. Perforation and obstructive symptoms are rare. The radiographic features of these ulcers are discussed and attention is drawn to the occasional occurrence of choledochoduodenal fistula and incompetence of the ampulla of Vater.

General hypothermia for managing gastrointestinal hemorrhage. A report of 3 cases in which total body hypothermia was used to control massive gastrointestinal hemorrhage.

Three patients with gastrointestinal hemorrhage were treated with prolonged total body hypothermia after other nonoperative measures failed. In each instance the bleeding stopped and has not recurred. Previous experience with operative procedures supported the decision against reoperation for control of hemorrhage. Recurrent bleeding from a postbulbar duodenal ulcer was diagnosed in one case but in the others the bleeding site was not known. Rectal or esophageal temperatures were kept between 30 and 32°C. It is recommended that rewarming begin 24 hours after bleeding has stopped. The satisfactory results in these three cases suggest further trials.

Postbulbar duodenal ulcer.

Peptic ulcer of the duodenum involving the postbulbar region presents important clinical and radiographic differences from the usual type of duodenal ulcer. It has been our experience that this type of ulceration is not a rarity, but occurs frequently enough to be given careful consideration in every patient undergoing gastrointestinal examination. The clinical findings in postbulbar duodenal ulcer do not differ significantly from those associated with the more commonplace ulcers of the bulb. It is important, then, for the radiologist to localize the site of ulceration accurately so that the clinician is better able to evaluate the future course and management. Bleeding occurs in 57 per cent of postbulbar ulcers, which is in striking contrast to the 19 per cent of bulbar ulcers and 23 per cent of gastric ulcers (1). This high incidence of bleeding, coupled with an increased frequency of intractability to treatment, makes the prognosis rather poor and demands special therapeutic considerations. The actual ...

POSTBULBAR DUODENAL ULCER

Article1 October 1957POSTBULBAR DUODENAL ULCERJOHN A. RAMSDELL, M.D., LLOYD G. BARTHOLOMEW, M.D., JAMES C. CAIN, M.D., F.A.C.P., GEORGE D. DAVIS, M.D.JOHN A. RAMSDELL, M.D.Search for more papers by this author, LLOYD G. BARTHOLOMEW, M.D.Search for more papers by this author, JAMES C. CAIN, M.D., F.A.C.P.Search for more papers by this author, GEORGE D. DAVIS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-47-4-700 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPostbulbar duodenal ulcer, as the name implies, is one situated in the duodenum distal to the duodenal bulb. Anatomically, such an ulcer is in the postbulbar part of the first portion, or in the second, third or fourth portion, of the duodenum. Fewer than 150 cases have been reported in the English literature in this century, the largest series being that of 18 cases reported by Swarts and Rice1in 1954. This type of ulcer may be extremely difficult to diagnose, inasmuch as specific diagnostic criteria have not been universally accepted. The purpose of this investigation was to determine in...Bibliography1. SwartsRice JMML: Post-bulbar duodenal ulcer with particular reference to its hemorrhagic tendency, Gastroenterology 26: 251, 1954. CrossrefMedlineGoogle Scholar2. BallSegalGolden RPALR: Post bulbar ulcer of the duodenum, Am. J. Roentgenol. 59: 90, 1948. Google Scholar3. PortisJaffé SARH: A study of peptic ulcer based on necropsy records, J. A. M. A. 110: 6, 1938. CrossrefGoogle Scholar4. SturtevantShapiro MLL: Gastric and duodenal ulcer: frequency, number, size, shape, location, color, sex and age in seven thousand seven hundred necropsy records at Bellevue Hospital, New York, Arch. Int. Med. 38: 41, 1926. CrossrefGoogle Scholar5. IvyGrossmanBachrach ACMIWH: Peptic ulcer, 1950, The Blakiston Company, Philadelphia. Google Scholar6. Morlock CG: Indications for the surgical treatment of peptic ulcer, Journal-Lancet 65: 8, 1945. Google Scholar7. Balfour DC: The surgical treatment of haemorrhagic duodenal ulcer, Ann. Surg. 96: 581, 1932. CrossrefMedlineGoogle Scholar8. AlvarezFariñas LFPL: Post-bulbar duodenal ulcers, Gastroenterology 8: 1, 1947. MedlineGoogle Scholar9. Wolke K, quoted by Borman, C. N.: Ulcer in the descending duodenum, Am. J. Roentgenol. 50: 752, 1943. Google Scholar10. Moynihan BG: Duodenal ulcer, 2nd Ed., 1912, W. B. Saunders Company, Philadelphia, p. 282. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Rochester, Minnesota*From the Symposium on Gastroduodenal Ulcer, presented at the Thirty-eighth Annual Session of The American College of Physicians, Boston, Massachusetts, April 11, 1957.From the Department of Surgery of the Mayo Foundation and the Sections of Medicine and Roentgenology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.The Mayo Foundation, Rochester, Minnesota, is a part of the Graduate School of the University of Minnesota.Requests for reprints should be addressed to Section of Publications, Mayo Clinic, Rochester, Minnesota. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byNature and treatment outcomes of bleeding post‐bulbar duodenal ulcersAnalysis of Recent Cases of Postbulbar Duodenal Ulcer in JapanPeptic ulcer as encountered in a surgical unit in South India a review of 198 casesPost-bulbar and coexisting ulceration: unique features of peptic ulcer in Hyderabad.Benign duodenocolic fistula: an unusual case of gastrointestinal bleedingPostbulbar duodenal ulcer in a patient with pentagastrin-fast achlorhydriaA clinicopathological study of post-bulbar duodenal ulcer —Analysis of 6 cases and comparison to usual chronic duodenal ulcer—Surgical management of acute hemorrhagic postbulbar duodenal ulcer after a previous major surgical procedurePostbulbar Duodenal UlcerDuodenal ulcers: early and late onset.X-Ray diagnosis of postbulbar duodenal ulcer by means of double air contrast methodPeptic Ulcerations in ChildhoodReferencesPOST-BULBAR DUODENAL ULCERMAST CELLS AND BASOPHIL LEUCOCYTESReview of Lesions of the Small IntestineThe Differential Diagnosis of Hepatitis, Cirrhosis and Surgical Jaundice 1 October 1957Volume 47, Issue 4Page: 700-710KeywordsDuodenal ulcersDuodenumGastroenterology and hepatologyGraduate medical educationHemorrhageHydrochloric acidPeptic ulcersSurgeryUlcers Issue Published: 1 October 1957 PDF downloadLoading ...

Postbulbar Duodenal Ulcer with Hemorrhage Occurring During Butazolidin Therapy

Summary A lesser curvature post bulbar duodenal ulcer complicated by moderately severe hemorrhage, occurring during Butazolidin therapy, is presented. A comparison of peptic ulcers occurring during oral Butazolidin therapy with those produced experimentally in animals is attempted. It is suggested that Butazolidin might be a useful tool in the experirrental production of peptic ulcerations. The author wishes to thank Dr. E. S. Kronenberg, Jr., for his permission to report this case.

Post-Bulbar Duodenal Ulcer with Particular Reference to its Hemorrhagic Tendency

Although there are numerous allusions to post-bulbar duodenal ulcer in the literature, these references for the most part consist of necessarily small series, case reports, statements that ulcer does occur in this location, and that bleeding is a frequent complication. However, even in such comprehensive monographs as that of Ivy, Bachrach, and Grossman, and that published under the auspices of the American Gastroenterological Association, little informa­ tion about the problem is available. I , 2 Bockus' treatise contains a short dis­ cussion of ulcer occurring distal to the duodenal cap.s Since we have been confronted with the existence of post-bulbar ulcer in 11 patients in the last 5 months and since 8 of these bled either for the first time or recurrently, our attention has been focused upon the problem m general and upon the complication of hemorrhage in particular. REVIEW OF THE LITERATURE Necropsy figures disclose an incidence of post-bulbar ulcer varying from 5% to 17%, the average incidence being 9.6%. These reports include 354 duodenal ulcers of which 34 were beyond the cap.4, 5, 6 Ball, Segal and Golden state that the incidence ranges from 5% to 17% in surgical cases of duodenal ulcer. They further estimate the radiographic incidence as 1% to 5%. 7 Review of the available literature from 1910 through 1951 revealed 112 clinical cases of ulcer distal to the bulb. 6 , 8-18 Reference to the presence or absence of hemorrhage was made in 63 of these cases. Thirty-six, or 57% experienced gross bleeding. Roentgenographic evidence of post-bulbar ulcer was present in 91% of the patients who were examined. Fifty-eight per cent of the entire group were submitted to operation. These results are summarized

Post-Bulbar Duodenal Ulceration

Summary 1.Only 10 cases of ulcer of the second portion of the duodenum were found in approximately 75,000 hospital admissions covering a period of 7 years. 2.The most frequent symptom was upper abdominal pain which failed to respond to ulcer therapy after having previously responded. 3.Gastrointestinal bleeding was the most common and serious complication observed in this series; 7 of 10 patients had hemorrhage of major proportions. 4.A niche was found on x-ray examination in one-half of the cases. The second sign of importance, narrowing and constriction of the lumen, was present in all cases in this series.