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[Duodenal post-bulbar ulcers. Diagnostic and therapeutic problems]
F Ghelase1, I Georgescu, St Ghelase
1Clinica de Chirurgie I, Spitalul Clinic de Urgenţă Craiova, U.M.E Craiova, Dolj. fane35@lycos.com
Chirurgia (Bucharest, Romania : 1990)
|April 21, 2006
Summary
Post-bulbar duodenal ulcers (PBDU) incidence remained constant despite overall duodenal ulcer decrease. PBDU requires surgical intervention due to diagnostic challenges and severe complications.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Clinical Medicine
Background:
- Duodenal ulcer morbidity decreased by 10-12% between 1991-2001.
- Post-bulbar duodenal ulcer (PBDU) incidence remained constant at 9.33% of all duodenal ulcers.
- PBDU presents diagnostic and therapeutic challenges due to anatomical and clinical complexities.
Purpose of the Study:
- To analyze the characteristics, diagnosis, and management of post-bulbar duodenal ulcers.
- To evaluate surgical outcomes for PBDU compared to general duodenal ulcers.
Main Methods:
- Retrospective analysis of 1235 duodenal ulcer cases from 1991-2001.
- Classification of PBDU into proximal (62.60%) and distal (37.40%) forms.
- Surgical interventions included gastric resection and vagotomy, with a preference for Bilroth II anastomosis.
Main Results:
- Definitive PBDU diagnosis was often intraoperative.
- Associated bilio-digestive lesions occurred in 26.08% of cases.
- PBDU had higher postoperative morbidity (12.17%), re-operation rates (6.05%), and mortality (3.47%) than general duodenal ulcers.
Conclusions:
- PBDU's aggressive etiology and complications warrant primary surgical intent.
- Radical surgical procedures are recommended for PBDU management.
- Surgical management of PBDU is associated with significant risks and requires careful consideration.