Benign giant gastric ulcer
Lulu, D.J.
American Surgeon 37(6): 357-362
1971
ISSN/ISBN: 0003-1348 PMID: 5578526 Document Number: 3203
In summary, our experience with benign giant gastric ulcers which measure 3 cm. or more in diameter is reported. The most common presenting symptoms were pain (100%) and bleeding (90%) of which 33% was "massive." This report includes ten cases of giant benign gastric ulcer. All patients underwent operation. The accuracy of x-ray diagnosis was 43%. In two instances of benign ulcer, laparotomy was performed and the ulcers were deemed "nonresectable" despite negative frozen sections in one instance. Both patients were re-operated upon by the author, one for continued bleeding which became massive; both had successful results. In the entire series no patient who underwent resection for massive bleeding (30%) died. During the same period we observed seven patients with carcinomas of the stomach who were believed to have gastric ulcerations. Three were classified as "giant" ulcers. The incidence of malignancy in our series of giant ulcers was 29%. We strongly urge aggressive treatment for giant gastric ulcer, but that the scope of resection be correlated with frozen sections so that the most surgically conservative approach be utilized. Antral resection is advocated in an uncomplicated benign ulcer unless hyperchlorhydria is present, in which case vagotomy is added. A more radical procedure should be dependent upon positive frozen sections, or massive bleeding from an ulcer beyond the scope of antral resection.
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