[Post-bulbar ulcer, features of diagnosis, tactics and surgical conduct]

Abstract

From the diversity of places of duodenal ulcers, those postbulbars represent particular anatomo-clinical forms, due to the implication of pancreas and liver, accompanying by chronic pancreatitis, relation with papilla, multitude of ulcers and their serious complications (giant ulcers, hemorrhages, penetrations). Our experience is based on 324 patients with PBU which have been operated during 30 years (1970-2000), which represent 7.4% from the total number of duodenal ulcers operated in the same period. Men/women rate is 8/1. Ages between 40-60 years old plead in favor of vascular element (hypoxia) in the determination of lesion of PBU. The medical treatment being usually reflector definitive the absolute surgical indication which needs special tactical and technical approaches, taking into consideration the particularities of duodenum, implication of pancreas, gallbladder and papilla. In the surgical treatment of PBU we used most frequently the operation Pean-Billroth I--128 cases (39%), followed by the conservative operations in association with vagotomy--122 cases (34.5%). We have got good postoperative results in using of the exclusion operations--42 cases (13%) and exclusion resections--Finstere-Plenk--26 cases (8%). Preservation of duodenum in the digestive transit was possible in 89% of cases. General postoperative mortality was 1.5%, in hemorrhages the postoperative mortality was 4.1%.