Complicated postbulbar duodenal ulcers: peculiar clinical features, diagnosis and treatment

Abstract

Domestic and foreign studies have examined the clinical manifestations, diagnosis, and surgical treatment of patients with complicated postbulbar duodenal ulcers. Elibrary.ru, the Russian National Library, and PubMed were searched for relevant scientific medical literature published between 1926 and 2023. The search focused on literature data on evidence-based medicine. Postbulbar peptic ulcers occurred in 3.6–17% with duodenal ulcers. It often has an atypical clinical course and is at risk of severe complications such as ulcerative bleeding, decompensated duodenal stenosis, and ulceration. Surgical intervention is technically difficult. Despite the expansion of diagnostic capabilities, in most cases, the exact localization of the ulcer in the postbulbar area was revealed only during an intraoperative revision of the duodenum. Surgical treatment of patients with complicated corneal ulcers is associated with a high risk of damage to important anatomical structures, postoperative complications, and high mortality. Existing methods of surgical treatment of complicated postbulbar ulcers are associated with increased risk of intra- and postoperative complications, such as damage to the bile ducts, pancreatic ducts, large blood vessels, development of acute postoperative pancreatitis, and duodenal stump failure, which lead to frequent adverse immediate and long-term results and mortality. The issue of choosing the optimal surgical treatment methods for complicated corneal ulcer remains definitively unresolved. Although numerous techniques are available, none is perfect. In general, peptic ulcer disease and its complications remain relevant in modern surgery. Compared with stomach and duodenal bulb ulcers, few studies have been devoted to complicated postbulbar ulcers, specifically on the peculiarities of their clinical manifestations, diagnosis, and treatment.

Keywords

vagotomy / gastrointestinal bleeding / postbulbar ulcers / perforation / pyloroplasty / stenosis / difficult duodenal stump / duodenal ulcer

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