J.Jpn. Surg. Soc.. 82(10): 1224-1230, 1981

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Original article

POSTOPERATIVE ACUTE GASTRODUODENAL ULCER

During the past 20 years, 97 patients with postoperative acute gastroduodenal ulcer were experienced in our clinic. Ulceration was appeared most frequently after operations for malignant diseases of the liver, bile duct and pancreas which were associated with severe obstructive jaundice. Only 23.5% of the patients showed hyperacidity in the gastric juice study. Complications such as obstructive jaundice, hypoproteinemia, anemia, acute renal failure, liver failure, lung diseases and diffuse peritonitis were considered to be the important stress factors. Ninety-one out of 97 patients (93.8%) died, and the most frequent cause of death was massive hemorrhage from acute ulcer. More than 60% of the patients had the lesions located in the fundus and body of the stomach, and more than 80% had those of multiple and superficial without the rupture of visible vessels. Retrospective study on the location of the lesions suggested the distal gastrectomy might be indicated in about 40% of the patients, and the total or subtotal gastrectomy in about 60%. Of seven patients (7.2%) subjected to surgery in our series, three (42.9%) were alive. On the other hand, the conservative treatment was effective in only three patients (3.3%). Conservative therapy was not effective in most of the patients with postoperative acute gastroduodenal ulcer. In some cases, it is necessary to perform surgical treatment immediately after confirming the location of lesions using emergency endoscopy and it is concluded that aggressive surgery might be the first of choice for lowering the high mortality rate in the most cases with this disease.

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