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Marginal ulcer perforation: a single center experience

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

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.

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Author notes

  1. S. K. Natarajan

    Present address: , 481 Yio Chu Kang Road, #03-01, Castle Green, Singapore, 787056, Singapore

Authors and Affiliations

  1. Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore

    S. K. Natarajan, D. Chua & V. G. Shelat

  2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    K. Anbalakan & V. G. Shelat

Authors
  1. S. K. Natarajan
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  2. D. Chua
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  3. K. Anbalakan
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  4. V. G. Shelat
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Corresponding author

Correspondence to S. K. Natarajan.

Ethics declarations

This study is exempted, since it is a retrospective analysis of clinical data only and does not involve live patients.

Conflict of interest

Natarajan S.K, Chua D, Anbalakan K, Shelat V.G declare that we have no conflict of interest.

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Natarajan, S.K., Chua, D., Anbalakan, K. et al. Marginal ulcer perforation: a single center experience. Eur J Trauma Emerg Surg 43, 717–722 (2017). https://doi.org/10.1007/s00068-016-0723-0

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  • DOI: https://doi.org/10.1007/s00068-016-0723-0

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