• 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)
Stabile BE, Hardy HJ, Passaro E. 'Kissing' Duodenal Ulcers. Arch Surg. 1979;114(10):1153–1156. doi:10.1001/archsurg.1979.01370340059010
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