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KMID : 0371319730150010047
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Journal of the Korean Surgical Society
1973 Volume.15 No. 1 p.47 ~ p.53
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Clinical evaluation of marginal ulcer 24 cases
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李喆相/Lee, Chul Sang
金富年/朴在寬/白鳳壽/Kim, Boo Yun/Park, Jae Kwan/Baik, Bong Soo
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Abstract
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Marginal ulcer is one of the most serious sequela of surgery for peptic ulcer and these ulcers occur in from 0. 5% to 36% of patient following gastric surgery.
24 cases of marginal ulcer were treated at the National Medical Center during 14-year period, from 1958 through 1972.
This paper present incidence, age and sex distribution, interval between operations, symptoms and signs, x-ray findings, analysis of pain, complication, location, gastric juice analysis, treatment, postoperative complications and postoperative results of marginal ulcer.
1. 12 patients developed marginal. ulcer following gastrojejunostomy, 6 patients following Billroth if, , 4 patients following vagotomy and gastrojejunostomy and 2 patients following Billroth I.
2. Cases consisted of 21 men and 3 women whose ages averaged 44,6 years with indivisual variation from 30 to 59 years.
3. Interval between primary operations and operations for marginal ulcer averaged 1. 8 years after gastric resection, 5. 2 years after gastrojejunostomy and 6 years after vagotomy and gastrojejunostomy.
4. Most frequent symptom was pain, ocurring in 22 of the cases. 10 of the cases had epigastric pain, 16 had more than moderate pain and the pain was related to meals in 16 cases.
5. Upper G-I series were taken in 20 cases, of which 8 cases revealed patches of barium near the stoma, deformity of the adjacent jejunal mucosa, ulcer crater and narrowing of the stoma with 40 percents of positive diagnosis.
6. Two important complications are hemorrhage and perforation which were 8 cases each other. 2 of the 8 cases of perforation were free perforation with generalized peritonitis.
7. The ulcer was found at the efferent jejunal loop near the stoma in 13 cases and anastomosis line in 10 cases.
8. 4 of the 15 cases to whom gastric juice analysis was done revealed hyperacidity and free Hcl was noted in every cases.
9. In the treatment of marginal ulcer, Billroth li was performed for the cases to whom primary operation was gastrojejunostomy or vagotomy and gastrojejunostomy.
Vagotomy alone or vagotomy and resection was done for the cases to whome primary operation was Billroth I or Billroth if.
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10. Postoperativ results of marginal ulcer were good in 21 cases but 3 had severe postgastrectomy symdrome and 1 case recurred.
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