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Article |

'Kissing' Duodenal Ulcers

Bruce E. Stabile, MD; Henry J. Hardy, MD; Edward Passaro Jr, MD
Arch Surg. 1979;114(10):1153-1156. doi:10.1001/archsurg.1979.01370340059010.
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• Among 70 cases of perforated duodenal ulcers treated by plication, eight were complicated by massive postoperative hemorrhage from a syncronous posterior "kissing" duodenal ulcer. Critical analysis revealed that only signs of gastrointestinal (GI) bleeding preoperatively had predictive value for postoperative hemorrhage. Twenty-four patients had one or more predictive signs, and eight actually bled postoperatively. There was a 50% mortality and 75% additional complication rate for the bleeders. In contrast, the nonbleeders had a mortality and a complication rate of only 18% and 35%, respectively. There was no observed superiority of either surgical or medical treatment for postoperative hemorrhage. In perforated duodenal ulcer with evidence of Gl blood loss, an intraoperative search for a posterior kissing ulcer is recommended. If a kissing ulcer is found, an acid-reducing operation and suture ligation of the ulcer is indicated.

(Arch Surg 114:1153-1156, 1979)


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