[Postbulbar hemorrhagic ulcer].

Although it is relatively rare (only 10,4% of the cases), post-bulbar ulcers have a rather complicated evolution. The authors have recorded 26 observations with digestive haemorrhage, 3 cases with perforations, 32 stenoses, and pancreatic penetration. These give raise to problems of surgical tactic and surgical technique. The frequency of haemorrhagic complications by post-bulbar ulcers, in relation with overall rates of duodenal ulcers, was of 32,5%. The authors present a study of 26 cases of post-bulbar haemorrhagic ulcers in patients with an average age of 47,4 years. Upper digestive haemorrhage was unique, massive, with vascular collapse (9 cases), without vascular collapse (9 cases)m and it occurred repeatedly in 8 patients. Since haemorrhage through penetrating post-bulbar ulcer in the pancreas is, as a rule, the result of vascular fistulae, the severity of the haemorrhage, the frequency of the relapse (sometimes of cataclysmal proportions), makes mandatory an early intervention, as near as possible to the onset of the haemorrhage. Radical interventions are to be preferred when angio-penetrating and haemorrhagic lesions are demonstrated. The authors have performed exploratory antro-pyloroduodenotomy followed by extensive gastrectomy of the Reichel-Polya type (in 20 cases with 5 deaths), Péan gastroduodenectomy (1 case), exclusion gastrectomy (3 cases with 1 death), and vagotomy associated to pylroplasty and haemostasis "in situ" in 2 cases.