Treatment of Gastric Ulcer

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PRIOR to Dragstedt’s popularization of vagotomy, gastric ulcer usually was treated by gastric resection. The results of gastric resection for gastric ulcer were good, and the operation afforded maximum protection against the presence or development of carcinoma.

Recently the good results that have been obtained by vagotomy in the treatment of duodenal ulcer and marginal ulcer have led to its use also in cases of gastric ulcer. Our experience with vagotomy in a small series of selected cases of gastric ulcer has been disappointing and has shown the danger inherent in assuming that any ulcerating lesion of the stomach is benign. Two cases are presented in tabular form to emphasize the difficulty of distinguishing between benign and malignant ulcers of the stomach and to point out the importance of removing the ulcer whenever it is possible to do so.

In one case a shallow ulcer, 0.5 cm. in diameter, appeared to be healing and was not demonstrable either by roentgenogram or by gastroscopy. Both the surgeon and the pathologist considered it to be benign until permanent pathologic sections proved it malignant. One side of this lesion was a benign ulcer showing no evidence of carcinoma, and it was from this area that the biopsy specimen was taken. However, permanent sections showed the other side to be an infiltrating carcinoma. In a second case a huge deep ulcer measuring 6 cm. by 4.5 cm., which the roentgenologist and the surgeon had assumed to be carcinoma, proved to be benign.

The Nature. . .



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