Related Experiment Video
Updated: Mar 15, 2026
Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience
Published on: December 4, 2023
Marginal ulcer perforation: a single center experience
S K Natarajan1,2, D Chua3, K Anbalakan4
1Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore. nsureshkhanna2003@yahoo.co.in.
Purpose:
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.
Conclusion:
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.
Insights
Marginal ulcer perforation (MUP) in gastrojejunostomy (GJ) patients rarely causes septic shock. Simple repairs like omental patch or primary closure are often sufficient, avoiding mandatory GJ revision.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Abdominal Surgery
Background:
- Marginal ulcers (MU) occur at the gastrojejunostomy (GJ) anastomosis.
- Complicated MUs, such as perforation (MUP), often necessitate surgical intervention.
- Current recommendations suggest revising the GJ anastomosis for MUP.
Purpose of the Study:
- To investigate the clinical presentation of marginal ulcer perforation (MUP).
- To evaluate the management strategies for MUP.
- To assess the outcomes of different MUP repair techniques.
Main Methods:
- A retrospective case series of 332 patients undergoing emergency surgery for perforated peptic ulcer over 5 years.
- Analysis focused on patients presenting with MUP.
Main Results:
- Nine patients (2.7%) presented with MUP, all on the jejunal side of the GJ.
- No MUP patients exhibited septic shock.
- Omental patch repair (44.4%) and primary closure (33.3%) were common, with no post-operative leaks, abscesses, or reoperations.
Conclusions:
- Marginal ulcer perforation (MUP) does not typically lead to septic shock.
- Omental patch repair or primary closure are effective management options for MUP.
- Revision of gastrojejunostomy (GJ) anastomosis is not always mandatory for MUP.
More Related Videos
Related Concept Videos
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:26Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:22Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
01:30Peptic Ulcer Disease I: Introduction
An acute ulcer, marked by superficial erosion and minimal inflammation, swiftly resolves upon identifying and addressing the underlying cause. In contrast, a chronic ulcer persists, potentially eroding through the muscular wall and forming fibrous tissue.
Peptic ulcers can also be...