Complicated Nonspecific Small-Bowel Ulcers

ABSTRACT

BACKGROUND: Nonspecific small-bowel ulcers occurring beyond the duodenum are relatively uncommon, and it is difficult to make an exact diagnosis preoperatively. The majority of patients require surgical treatment for complications such as bleeding, perforation, or stenosis. METHODS: Fifteen cases (11 males and 5 females) of complicated nonspecific small-bowel ulcers occurring between 1990 and 1999 were retrospectively analyzed at the Department of Surgery, Holy Family Hospital, the Catholic University of Korea. RESULTS: The mean age of the patients was 52.4 years, and the most prevalent age was in the 4th decade (30%). The ratio of males to females was 2.81, and the predominant presenting symptoms were blood loss (13.3%), intestinal obstruction (20%), and an acute abdomen (66.7%). Two had chronic gastrointestinal hemorrhages, three had strictures, resulting in intestinal obstruction, and ten had perforations. The majority of ulcerations were located in the ileum (80%), and perforation was by far more common in the jejunum (100%) than in the ileum (58.3%). A small-bowel enema was a more reliable diagnostic technique than other radiologic modalities, such as sonography or computerized tomography, for delineating the bleeding or the stenotic foci. Surgical resections of the involved segments of the small bowels were curative in all but one perforation case, an 81-year-old female with postoperative multiple-organ failure. CONCLUSIONS: The exact diagnosis was rarely made preoperatively although abnormalities were noted roentgenographically in 80% (four out of five bleeding and stricture cases). Resection of the involved small bowel was the treatment of choice and was usually curative. Operative mortality was 6.7%. No etiologic causes could be determined pathologically.