The Roentgenologic Diagnosis of Jejunal or Marginal Ulcer

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PROMPTED by a desire to improve our accuracy in the roentgenologic diagnosis of marginal or jejunal ulceration, we reviewed all cases in which exploration had been carried out because of a provisional diagnosis of such ulceration. Fifty-six patients who had been operated upon within six months of roentgenologic examination are included in this series.

Of these 56 cases, a marginal or jejunal ulcer was found at surgery in 37 patients. Scarring at the site of anastomosis without evidence of ulcer was evident in two patients, a jejuno-gastro-colic fistula was found in four instances and a gastroileostomy in two. In 11 cases there was no evidence of ulceration.

In the 37 surgically proved ulcers a positive radiographic diagnosis had been made in 19. An equivocal diagnosis had been made in seven and a negative diagnosis in 11 cases. This corresponds to the findings of Priestley and Gibson1 who report 52 per cent accuracy in the roentgenographic diagnoses of marginal ulcers.

Ulcers were presumed to have been present in both cases in which scarring was found at the site of anastomosis.

Correct diagnoses were made in three cases of gastro-jejuno-colic fistula prior to surgery, and in one case of gastroileostomy.

Of the 11 negative explorations, correct preoperative diagnoses were made in five, equivocal diagnoses in three, and positive or incorrect diagnoses in three cases.

Twenty-four patients with proved ulcer had had simple gastroenterostomies; in five, gastroenterostomies had been combined with vagotomies; seven had undergone subtotal gastric resections and, in one case, the . . .



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