Complicated marginal ulcers after surgery for duodenal ulcer

Area of Science:

• Gastroenterology
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Marginal ulcers (MU) are a known complication following surgical treatment for duodenal ulcers.
• Identifying the causes and effective management strategies for MU is crucial for patient outcomes.

Purpose of the Study:

• To retrospectively evaluate the causes, clinical presentation, diagnostic methods, and surgical management of marginal ulcers (MU) after duodenal ulcer surgery.
• To assess the long-term outcomes and recurrence rates following surgical intervention for MU.

Main Methods:

• Retrospective analysis of 10 patients diagnosed with marginal ulcers (MU) over a 10-year period.
• Review of clinical data, including symptoms, diagnostic procedures (gastroscopy, Hollander test, insulin-induced acid output), and surgical interventions.
• Evaluation of postoperative complications and long-term follow-up.

Main Results:

• Inadequate gastric resection combined with incomplete vagotomy was the most frequent cause of MU.
• Epigastric pain was the predominant symptom in 80% of cases.
• Complications included perforation, bleeding, gastrojejunocolic fistula, and afferent loop obstruction. Total gastrectomy and truncal vagotomy were among the surgical treatments performed, with postoperative complications noted in 33% of patients. One patient with malignant gastrinoma and fistula died due to sepsis.

Conclusions:

• Incomplete vagotomy and inadequate gastric resection are primary contributors to marginal ulcer formation.
• Prompt diagnosis and appropriate surgical management are essential for treating MU and its complications.
• Long-term follow-up indicates a low recurrence rate after surgical intervention for MU.