Giant duodenal ulcer: a dangerous variant of a common illness.

Giant duodenal ulcers are large posterior penetrations of the duodenum which, when undiagnosed, have a high mortality. Radiographic and endoscopic diagnosis, although not always feasible, enables prompt appropriate management with improved results. Nonoperative treatment is dangerous. Preoperative diagnosis permits planned operative treatment and enables the surgeon to avoid a difficult duodenal dissection. The Bancroft operation, or modification thereof, is the operation of choice. Sixteen consecutive patients with giant duodenal ulcer are described. The success of their treatment is attributed to accurate diagnosis and appropriate operative therapy.

Hepatic changes in young women ingesting contraceptive steroids. Hepatic hemorrhage and primary hepatic tumors.

Primary hepatic tumors developed in 13 young women who had been ingesting contraceptive steroids. Nine tumors were benign, and four malignant. Six tumors ruptured spontaneously and caused life-threatening hemorrhage. Benign tumors were successfully resected in eight women. One woman died during hepatic resection for malignant hepatoma; in two other cases of hepatocellular carcinoma, tumors were nonresectable. In two patients, the tumor was left in situ after neoplasm had been excluded by biopsy. The increase of such tumors in women of childbearing age warrants the suspicion that these contraceptive steroid hormones play an etiologic role.

A few women taking the pill found to have benign liver tumors.

PIP: At least 50 proven cases of liver tumors following use of oral contraceptives have been reported. The authors reports 12 in his practice but thinks may have gone unrecognized elsewhere. The 11 cases reported to the surgical meeting in Miami Beach were solitary primary tumors in nonalcoholic and otherwise healthy women with an average of 32 years. Of these 6 had been taking oral contraceptives for 5 or more years, 3 for 2 years or less, and 2 for 1 year or less. Several had catastrophic hemorrhage, abdominal pain, and shock. Hemoperitoneum was found at laparotomy. In 2 cases the tumors were malignant. In 5 cases the tumors had not bled but were found incidentally at laparotomy. No particular type of contraceptive was correlated. sometimes the patient had detected a lump in the right upper part of the abdomen. All tumors were hepatocellular. The tumors were hamartoma, focal nodular hyperplasia, and adenoma or hepatocellular carcinoma.^ieng