Marginal ulcer perforation: a single center experience

Purpose Marginal ulcer (MU) is defined as ulcer on the jejunal side of the gastrojejunostomy (GJ) anastomosis. Most MUs are managed medically but those with complications like bleeding or perforation require intervention. It is recommended that GJ anastomosis be revised in patients with MU perforati...

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Bibliographic Details
Published in:European journal of trauma and emergency surgery (Munich : 2007) 2017-10, Vol.43 (5), p.717-722
Main Authors: Natarajan, S. K., Chua, D., Anbalakan, K., Shelat, V. G.
Format: Article
Language:English
Subjects:
Abscesses
Adult
Aged
Aged, 80 and over
Critical Care Medicine
Emergency Medicine
Female
Humans
Intensive
Male
Medicine
Medicine & Public Health
Middle Aged
Original Article
Peptic Ulcer - complications
Peptic Ulcer Perforation - epidemiology
Peptic Ulcer Perforation - etiology
Peptic Ulcer Perforation - surgery
Reoperation
Retrospective Studies
Sepsis
Singapore - epidemiology
Sports Medicine
Surgery
Surgical Orthopedics
Traumatic Surgery
Ulcers
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Summary:Purpose Marginal ulcer (MU) is defined as ulcer on the jejunal side of the gastrojejunostomy (GJ) anastomosis. Most MUs are managed medically but those with complications like bleeding or perforation require intervention. It is recommended that GJ anastomosis be revised in patients with MU perforation (MUP). The aim of this case series is to study the clinical presentation and management of MUP. Methods Three hundred and thirty-two patients who underwent emergency surgery for perforated peptic ulcer at a single center were studied over a period of 5 years. Results Nine patients (2.7 %) presented with MUP. GJ was previously done for either complicated peptic ulcer ( n  = 4) or for suspected gastric malignancy ( n  = 5). Two patients had previously completed H. pylori therapy. None of the patients presented with septic shock. MU was on the jejunal side of GJ in all patients. The median MUP size was 10 mm. Four patients (44.4 %) had omental patch repair, three (33.3 %) had primary closure, and one each had revision of GJ and jejunal serosal patch repair. There were no leaks, intra-abdominal abscess or reoperation and no malignancies. Conclusion MUP patients do not present with septic shock. Omental patch repair or primary closure is sufficient enough. Revision of Billroth-II-GJ into Roux-en-Y-GJ is not mandatory.
ISSN:1863-9933
1863-9941
DOI:10.1007/s00068-016-0723-0