Current Trends in the Treatment of Jejunal Ulcer
Until recent years the treatment of jejunal ulcer was considered a surgical problem. Recent communications show a trend toward medical management, except in patients with obvious indications for immediate surgery, such as perforation or gastrojejunocolic fistula. In a series of 29 consecutive cases observed at the Cleveland Clinic during the years 1930–1941, inclusive, immediate surgery was used in 4 cases, and medical management was instituted in 25 cases. Of the latter group 7 patients were not followed after the initial period of treatment, but 18 patients are known to have continued with medical management alone. The unusual swing of the pendulum to medical management prompted this review.
In recent years nonabsorbable antacids have been used in the treatment of peptic ulcer. The use of aluminum hydroxide gel was considered an important factor in the medical management of this group of patients.
In this study the term “jejunal ulcer” includes ulcers which develop subsequent to gastric surgery in the region of the anastomosis between the stomach and jejunum. Synonymous terms in the literature are stomal, anastomotic, or marginal ulcer. All patients had evidence of active jejunal ulcer by x-ray or gastroscopic examination, or both, at the time the diagnosis was established.
The 4 patients undergoing surgery had serious complications of jejunal ulcer. Two patients had subacute perforations with abscess formation, and two had gastrojejunocolic fistulas. Other complications of jejunal ulcer, such as obstruction and massive hemorrhage, when not controlled by adequate medical management, call for surgical intervention.