[Postbular duodenal ulcer. Problems of diagnosis and treatment. Role of vagotomy in surgical treatment].

A number of 43 cases is presented, of post-bulbar duodenal ulcers in which surgery has been performed between 1965 and 1974, of which 30 were located in the first portion of the duodenum, in the postbulbar area, and 15 in the second portion, above the ampula of Vater. Problems of terminology and pathological anatomy are discussed, especially in connection with the symptomatology, complications, methodology of investigations and treatment of post-bulbar ulcers. The particular frequency is stressed, of complicated clinical forms, with stenosis and hemorrhagies, and a detailed description is made of atypical forms, with misleading, predominantly biliary or pancreatic symptomatology. Conditions are stressed, of the radiologic gastroduodenal exploration, of major importance in the diagnosis preceding surgery, as well as of pre- and intra-surgery cholangiography. The risk must be carefully evaluated, in the choice of the surgical method, and exeresis of the ulcer must be balanced with the risk of its continued presence. Priority should be given to th risks entailed by surgery. The choice solution in many cases is vagotomy associated to exclusion resection or to gastric derivation.