Giant gastric and duodenal ulcers: A population‐based study with a comparison to nongiant ulcers

Abstract

Among 454 operations done for peptic ulcer between 1956 and 1985 on residents of Rochester, Minnesota, U.S.A. in whom ulcer size could be determined accurately, 50 operations (11% of the total) were performed for giant ulcers and 404 (89%) for nongiant ulcers. The annual operation rate per 100,000 residents for giant ulcer did not clearly decline during the 30‐year period in contrast to the dramatic fall in operation rates for nongiant ulcers. Nonetheless, the ratio of operation rates for giant ulcer compared to nongiant ulcer changed relatively little. Giant ulcers required emergency operation for massive bleeding more often than nongiant ulcers. Also, giant ulcers presented with unusual and severe complications such as gastrocolic fistula. Survival after surgery for giant ulcer was poorer than survival after an operation for nongiant ulcer. We conclude that giant ulcers are operated on somewhat less often today than in the past, while operations for nongiant ulcers are much less frequent. The giant ulcers that are operated on, however, are more prone to massive bleeding and are associated with poorer postoperative survival than their nongiant counterparts.

Peptic Ulcer Disease in the Elderly

“…A penetrating ulcer may involve contiguous organs, occasionally with fistulization. Bleeding is almost inevitable at some stage and is the most frequent indication for emergency operation (42). Intractibility.…”

Emergent Repair of a Perforated Giant Duodenal Ulcer in a Patient With an Unmanaged Ulcer History

“…GDUs are closely associated with typical risk factors for peptic ulcer disease (PUD) with a slightly stronger correlation with aspirin and nonsteroidal anti-inflammatory drug (NSAID) use rather than Helicobacter pylori (H. pylori) infection [5]. The lifetime prevalence of duodenal ulcers is 11-20% for men and 8-11% for women and of those diagnosed, 5% will eventually necessitate operative intervention [6,7]. Worsening outcomes and risk of duodenal ulcer perforation are inversely correlated with the length of time before management is implemented [8].…”