October 1979

'Kissing' Duodenal Ulcers

Author Affiliations

From the Department of Surgery, UCLA School of Medicine (Drs Stabile, Hardy, and Passaro), and the Surgical Service, Veterans Administration Wadsworth Medical Center, Los Angeles (Drs Stabile and Passaro).

Arch Surg. 1979;114(10):1153-1156. doi:10.1001/archsurg.1979.01370340059010

• Among 70 cases of perforated duodenal ulcers treated by plication, eight were complicated by massive postoperative hemorrhage from a syncronous posterior "kissing" duodenal ulcer. Critical analysis revealed that only signs of gastrointestinal (GI) bleeding preoperatively had predictive value for postoperative hemorrhage. Twenty-four patients had one or more predictive signs, and eight actually bled postoperatively. There was a 50% mortality and 75% additional complication rate for the bleeders. In contrast, the nonbleeders had a mortality and a complication rate of only 18% and 35%, respectively. There was no observed superiority of either surgical or medical treatment for postoperative hemorrhage. In perforated duodenal ulcer with evidence of Gl blood loss, an intraoperative search for a posterior kissing ulcer is recommended. If a kissing ulcer is found, an acid-reducing operation and suture ligation of the ulcer is indicated.

(Arch Surg 114:1153-1156, 1979)