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

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Abstract

Domestic and foreign studies have examined the clinical manifestations, diagnosis, and surgical treatment of patients with complicated bulbous 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. Bulbous 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 bulbous 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 bulbous ulcers, specifically on the peculiarities of their clinical manifestations, diagnosis, and treatment.

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About the authors

Sergey I. Peregudov

Kirov Military Medical Academy; Saint Petersburg Institute of Emergency Care named after I.I. Dzhanelidze

Email: drsip@yandex.ru
ORCID iD: 0000-0001-5755-1311
SPIN-code: 1634-1543
Scopus Author ID: 6601994777

MD, Dr. Sci. (Med.), professor

Russian Federation, Saint Petersburg; Saint Petersburg

Son T. Luong

Kirov Military Medical Academy

Author for correspondence.
Email: vmeda-nio@mil.ru
ORCID iD: 0009-0008-2530-8593
SPIN-code: 4883-4503
ResearcherId: JYP-4783-2024

clinical resident

Russian Federation, Saint Petersburg

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