2-cm ulcer of the distal lesser curvature

Discussion in 'MRCS Forum' started by Kim., Mar 28, 2008.

  1. Kim.

    Kim. Guest

    A 55-year-old man complains of chronic intermittent epigastric pain, and Gastroscopy demonstrates a 2-cm ulcer of the distal lesser curvature. Endoscopic biopsy yields no malignant tissue. After a 6-week trial of H2 blockade and antacid therapy, the ulcer is unchanged. Proper therapy at this point is -
    a- Repeat trial of medical therapy
    b- Local excision of the ulcer
    c- Billroth I partial Gastrectomy
    d- Billroth I partial Gastrectomy with vagotomy
    e- Vagotomy and pyloroplasty
  2. Kim.

    Kim. Guest

    Answer: c. (Greenfield, 2/e, pp 779-787) benign gastric ulcers have a peak incidence in the fifth decade, with male predominance. About 95% of gastric ulcers are located near the lesser curvature. It should be recognized that up to 16% of patients with gastric carcinoma pass a 12-week healing trial and that benign ulcers may enlarge during medical therapy. Therefore, the possibility of malignancy must be assessed by biopsy despite a 5 to 10% false-negative rate. Six weeks of medical therapy will heal many gastric ulcers, but a recurrence rate as high 63% and the serious consequence of complications in this older group of patients warrant surgery for recurrent or nonhealing ulcers. A distal Gastrectomy with gastroduodenostomy is usually feasible in the absence of duodenal disease. Vagotomy, while advocated by some, is generally not included. Local excision with definitive distal resection or vagotomy and pyloroplasty is appropriate for a proximal ulcer that would otherwise require a subtotal gastrectomy.

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