The Importance of Giant Duodenal Ulcer

Giant duodenal ulcer

“…Lemaire et al (1966) found 15 deaths in 37 published cases, a mortality of 405 %. Since then Kirsh and Brendel (1968) have reported one death in six cases and Rosenquist one in nine; these added to our own figures (five deaths in 25 cases) give a total of seven deaths in 40 cases, a mortality of 17.5 %.…”

“…We ourselves have seen healing in two cases (13 and 25). Kirsh and Brendel (1968) thought that the mere presence of a giant duodenal ulcer should be regarded as an indication for surgery, but we believe that whenever possible medical treatment should be tried first. In many cases it will be simply a prelude to surgery, its aim being to improve the patient's general condition and allow time for any inflammatory swelling around the ulcer to subside.…”

“…We have already mentioned a review of the literature by Kirsh and Brendel (1968) in which 42 cases were regarded as proven and there had been a correct radiological diagnosis in only 24. In a series of their own, which they did not report in detail, there was a correct diagnosis in 25 out of 30 cases.…”

“…Further reviews have been published by Mistilis, Wiot, and Nedelman (1963), who found 34 previously reported cases and tabulated the clinical findings in 14 cases of their own, by Lemaire, Blanchon, Emerit, Yean, Tavernier, and Giorgi (1966), who added two cases to 40 found in the literature, and by Kirsh and Brendel (1968). The last named authors accepted as proven cases of benign giant duodenal ulcer only those in which the crater was at least 2 cm in size, an x-ray examination had preceded a surgical operation or necropsy, and there was proof that the lesion was benign.…”

Giant duodenal ulcers

“…Although Mistilis [2] and Kirsh et al [6] proposed that the diagnosis of a giant duodenal ulcer was an indication for surgery, Lumsden [4] has suggested that a course of intensive medical therapy be attempted first. Our series strongly supports the latter view.…”