Management of giant duodenal XXXX .

@entity1 @entity1066 @entity360 @entity548
Giant duodenal @entity1066 is a variant of peptic @entity1066 that is 2 cm in diameter or greater and essentially replaces the duodenal bulb. Diagnosis by upper gastrointestinal series is often missed, due to the large size of the @entity1066 , which causes it to look like a scarred duodenal bulb or duodenal diverticulum. This study reviews our experience with 32 @entity1 who presented with giant duodenal @entity1066 between 1963 and 1982. Seventy-five percent of the @entity1 were @entity1 between 30 and 81 years of age (mean age 59 years). @entity360 was a presenting symptom in 75 percent of the @entity1 and free perforation in 9 percent. Diagnosis was made by upper gastrointestinal series (24 @entity1 ), and endoscopy (11 @entity1 ), alone or in combination. Three @entity1 were diagnosed at surgery and one at necropsy. Mean size of the @entity1066 was 3.5 cm in diameter, range 2 to 6 cm. Twenty-four @entity1 were initially managed medically (mean length of treatment 41 months), with 2 deaths ( @entity548 ) and 20 recurrences (83 percent). Twenty-seven operations were required in 25 @entity1 . In 17 of the 25, medical treatment had failed. Seven of these @entity1 required emergency surgery. Eight @entity1 were managed primarily by surgery, of whom five presented emergently. There were three deaths in the surgical group after emergency surgery. In two of these @entity1 , medical treatment had failed. There were no deaths among the elective surgery group. Twenty-five of the 27 operative procedures were definitive, acid-reducing operations (15 vagotomy and antrectomy and 10 vagotomy and drainage). Two @entity1 underwent emergency exploration and oversewing of a giant perforated @entity1066 alone, and both @entity1 required subsequent surgery because of symptoms. The results indicate that giant duodenal @entity1066 should be primarily surgically managed and that an acid-reducing procedure should be performed during primary surgery. These @entity1 do very poorly with medical therapy, and the mortality rate is increased if emergency surgery is required for @entity548 . Medical treatment alone is associated with a high morbidity (92 percent). Should operation be required, a definitive acid reduction operation is the procedure of choice.
