[Severe digestive hemorrhage from ulcers on the posterior surface of the first part of the duodenum: clinical aspects and therapeutical results in 107 cases (author's transl)].

The mode of onset, and clinical, radiological, and endoscopic findings in 107 cases of digestive hemorrhage are described, as well as variations in the period elapsing between onset and surgical intervention. Indications for surgery and the results obtained are analyzed. Operation consisted of subdiaphragmatic truncal vagotomy in 74 cases (followed by pyloroplasty in 68 and gastroenterostomy in 6 cases), gastroduodenal resection in 23 cases (with subsequent gastrojejunal anastomosis in 17 and gastroduodenal anastomosis in 6 cases), resection for exclusion operation as described by Finsterer in 8 patients, and highly selective vagotomy with pyloroplasty in 2 cases. Hemorrhage reoccurred in 12 patients (11.2 p. cent), after vagotomy and pyloroplasty in 11 patients (with 3 deaths), and one case after resection. Of the 8 early relapses, 4 were treated medically, leading to 2 recoveries and 2 deaths, the other 4 patients being treated by gastroduodenal resection, with subsequent recovery in 5 cases and one death. The 4 patients with late recurrences were successfully treated medically (2 cases) or surgically (2 cases). Though Weinberg's operation can still be considered as the basic operation in patients with hemorrhage from ulcers on the posterior in patients with hemorrhage from ulcers on the posterior wall of the duodenum, immediate gastric resection is still a valid procedure for large ulcers with thickened walls. Early relapse of hemorrhage after Weinberg's operation should be treated by resection.