Coincident Duodenal and Gastric Ulcer

THE surgical treatment of duiodenal and gastric ulcer is still the subjectof cointroversy, and opinion is sharply divided as to ther exact place whi-ch surgery should hold, and will ultimately -maintain, iA the treatmiient of this disorder. There is, -howviear', ani imposing accumulation of evidence of the curative actioni of a gastro-enterostomiiy in cases-of duodenal ulcer. Collective statistics show that colmplete relief from_ symp-toms follow-s in 85 per cent, of cases of duodenal ulcer followiing gastro-eniterostonmy. For gastric ulcer, on the other hand, this operation is much less successful, and most surgeons are agreed that when the ul er is situated on the lesser curvature of the stomach a direct attack on it of one kind or another is essential for a lasting cure. The object of this paper is not to analyse the causes of non-success followinig gastro-enterostomy for duodenal ulcer furtlher than to point out the frequency with which a coincident ulcer is present in the stomach, an uleer whicl is liable to escape observation unless a systematic seareli is ma(le for, it. ]Ouiing the three years p'iorl to th-e mar I examined iii the pec-ma{rtem roomn 490 bodies for duodenal ulcer. In 41 bodies one ormore duodenal ulcers were founidc that is, in, 8 per cent. In 5 cases one or more gastric uilcers werepresenlt along with the duodenal ulcers -thalt is, in 12 per cent.'of cases of duodenal ulcer a coincident gastric ulcer. 'was found (Fig; 1). WhIilst, therefore, fully aware of the frequent association of ulcer in bothi stomach and duodenum, I confess to have omitted to make a systematic examination for multiple ulceris in all upler abdomiinal operations until five years ago, wlhen the followinig case brouglht lhome to me the importanice of a comjplete assessment of pathology At operation.