[The hemorrhagic duodenal ulcer: our experience in its diagnosis and treatment]

Abstract

Aim of the paper: To present our experience in the diagnosis and treatment of hemorrhagic duodenal ulcer.

Material and method: Retrospective study of 80 patients who underwent surgery in our clinic during the past 5 years. Patient's age ranged between 19 and 76 years, the condition being most common during the IVth and Vth decades of life. There were 61 males and 19 female, 49 of them residing in urban areas. In 23 cases the patients presented with an acute hemorrhagic ulcer and in 57 cases with a chronic form. Hemorrhage was by hematemesis (30 cases), melena (36 cases) and hematemesis and melena (14 cases). According to the severity of hemorrhage we found: hemorrhagic shock grade I (mild hemorrhage) in 16 cases, grade II (moderate hemorrhage) in 19 cases, grade III (severe hemorrhage) in 33 cases, grade IV (very severe) in 11 cases and grade V (cataclysmic) in 1 case. Radiological and endoscopic examinations made the diagnosis in 78 and 95% of the cases, respectively. Treatment was surgical in all cases. The patients were operated in emergency, within the first 24 hours (14 cases), or delayed emergency, after 4-7 days (66 cases). Two surgical procedures were performed: truncal vagotomy with ulcer excision/suture and Heineke-Mikulicz pyloroplasty in 46 cases, and truncal vagotomy with antrectomy and Péan anastomosis in 34 cases.

Results: Postoperative course was favorable in 76 cases, complications causing death being recorded in 4 cases.

Conclusions: Hemorrhagic gastroduodenal ulcer is a surgical emergency requiring an adequate diagnostic and therapeutic approach. According to our statistics, in most cases the treatment is surgical.