Marginal Ulcer Following Gastric Resection for Benign Gastric Ulcer

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THE development of a marginal ulcer following gastric resection of a gastric ulcer is unusual. Balfour, cited by Bockus,1 reported that marginal ulcer occurred 20 times more frequently after operations for duodenal ulcer than after surgery for gastric ulcer. Kiefer2 obtained follow-up studies on 49 patients with gastric ulcers subjected to subtotal gastrectomy, and found no evidence of recurrence in any of the patients. Of 146 patients with duodenal ulcer and 27 patients with jejunal ulcer subjected to gastric resection, 6 or 3.4 per cent developed marginal ulceration as proved at subsequent operations. Bockus1 reported that marginal ulceration rarely occurred even after a gastrojejunostomy was performed for gastric ulcer. Ranson3 followed 188 patients who underwent gastric resection for gastric ulcer and found that only 4 had de veloped marginal ulcers. In at least 2 and possibly 3 of the patients the antrum was not removed, a Finsterer operation having been performed. The presence of the antrum, with the continued secretion of the antral hormone as shown by Dregstedt, can predispose to the development of an anastamotic ulcer. In none of the 4 patients with a marginal ulcer was a Bilroth I type of procedure done.

The occurrence of a marginal ulcer is dependent on gastric acidity and the presence of free HCl, just as any peptic ulcer. Klein et al4 found that immediate postoperative anacidity was present in 77 per cent of patients with gastric ulcer following resection, and in only 38 per cent of patients with duodenal ulcer who. . .



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