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PubMed2000

Surgical management of peptic ulcer disease today--indication, technique and outcome.

AIMS: The current surgical management of peptic ulcer disease and its outcome have been reviewed. RESULTS: Today, surgery for peptic ulcer disease is largely restricted to the treatment of complications. In peptic ulcer perforation, a conservative treatment trial can be given in selected cases. If laparotomy is necessary, simple closure is sufficient in the large majority of cases, and definitive ulcer surgery to reduce gastric acid secretion is no longer justified in these patients. Laparoscopic surgery for perforated peptic ulcer has failed to prove to be a significant advantage over open surgery. In bleeding peptic ulcers, definitive hemostasis can be achieved by endoscopic treatment in more than 90% of cases. In 1-2% of cases, immediate emergency surgery is necessary. Some ulcers have a high risk of re-bleeding, and early elective surgery might be advisable. Surgical bleeding control can be achieved by direct suture and extraluminal ligation of the gastroduodenal artery or by gastric resection. Benign gastric outlet obstruction can be controlled by endoscopic balloon dilatation in 70% of cases, but gastrojejunostomy or gastric resection are necessary in about 30% of cases. CONCLUSIONS: Elective surgery for peptic ulcer disease has been largely abandoned, and bleeding or obstructing ulcers can be managed safely by endoscopic treatment in most cases. However, surgeons will continue to encounter patients with peptic ulcer disease for emergency surgery. Currently, laparoscopic surgery has no proven advantage in peptic ulcer surgery.

Humans↗
PubMed1998

Diseases that simulate acute appendicitis on ultrasound.

Ultrasound is useful in the assessment of patients with possible appendicitis. A diagnosis of appendicitis can be made in patients with persistent right lower quadrant pain when a non-compressible appendix greater than 6 mm in diameter is shown. When a normal appendix is affected by an adjacent lesion, reactive inflammation can cause secondary enlargement of the appendix. This article reviews ultrasound findings in conditions which can clinically mimic acute appendicitis. Examples of Crohn's disease, tuboovarian abscess, typhilitis, sigmoid diverticulitis, perforated sigmoid neoplasm, perforated peptic ulcer, perforated acute cholecystitis, caecal carcinoma and appendiceal tumours are included.

Acute Disease↗
PubMed1980

Observations on management of choledochoduodenal fistula due to penetrating peptic ulcer.

Perforation into the biliary tract is a rare complication of benign peptic ulcer disease. This report describes our experience with 4 patients having this problem. The resulting choledochoduodenal fistula itself causes no unique symptoms in most cases. The diagnosis, hithertofore unsuspected, is most commonly made during barium examination of the upper gastrointestinal tract in patients with typical complaints of ulcer disease. Endoscopy and retrograde cholangiography may be useful to define the pathologic anatomy and to distinguish peptic ulcer disease from primary biliary tract disease or malignant ulcer. Medical management of the underlying ulcer disease with cimetidine and antacids usually suffices to relieve symptoms and to allow healing of the fistula. Surgery becomes necessary if biliary stenosis or cholangitis occurs, or if other aspects of the ulcer disease mandate operative treatment.

Aged↗