RT Journal
A1 Stabile BE, Hardy HJ, Passaro E, Jr
T1 'kissing' duodenal ulcers
JF Archives of Surgery
JO Archives of Surgery
YR 1979
FD October 1
VO 114
IS 10
SP 1153
OP 1156
DO 10.1001/archsurg.1979.01370340059010
UL http://dx.doi.org/10.1001/archsurg.1979.01370340059010
AB • 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)