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September 1963

Portal Hypertension From Postbulbar Duodenal Ulcer

Author Affiliations

Clinical Investigator, Veterans Administration Hospital; Instructor in Surgery, University of Washington School of Medicine (Dr. Strandness). Chief, Surgical Service, Veterans Administration Hospital; Associate Professor of Surgery, University of Washington School of Medicine (Dr. Bell).; From the Surgical Service, Veterans Administration Hospital and Department of Surgery, University of Washington School of Medicine.

Arch Surg. 1963;87(3):440-441. doi:10.1001/archsurg.1963.01310150076016

Introduction  Postbulbar duodenal ulcers comprise about 5% to 10% of all duodenal ulcers.1-6 These lesions have a greater tendency to bleed massively, often are deeply penetrating, and frequently require surgical therapy. More uncommon complications of this ulcer are duodenal obstruction and obstruction of the common bile duct. Because of their location in the second portion of the duodenum, visualization on upper gastrointestinal series is often difficult. We have recently had the opportunity to observe two patients who had extrahepatic portal vein obstruction and portal hypertension resulting from this disease. The portal vein was occluded by massive periduodenal scarring and inflammation. Although many causes for extrahepatic vein obstruction have been noted, postbulbar duodenal ulcer has not been reported even as a cause.7 Because of the problems encountered in differential diagnosis, these cases will be reported in detail.

Case 1.  —This 68-year-old white male was admitted Jan 12, 1959, with