'Kissing' duodenal ulcers

Arch Surg. 1979 Oct;114(10):1153-6. doi: 10.1001/archsurg.1979.01370340059010.


Among 70 cases of perforated duodenal ulcers treated by plication, eight were complicated by massive postoperative hemorrhage from a syncronous posterior "kissing" duodenal ulcer. Critical analysis revealed that only signs of gastrointestinal (GI) bleeding preoperatively had predictive value for postoperative hemorrhage. Twenty-four patients had one or more predictive signs, and eight actually bled postoperatively. There was a 50% mortality and 75% additional complication rate for the bleeders. In contrast, the nonbleeders had a mortality and a complication rate of only 18% and 35%, respectively. There was no observed superiority of either surgical or medical treatment for postoperative hemorrhage. In perforated duodenal ulcer with evidence of GI blood loss, an intraoperative search for a posterior kissing ulcer is recommended. If a kissing ulcer is found, an acid-reducing operation and suture ligation of the ulcer is indicated.

MeSH terms

  • Aged
  • California
  • Duodenal Ulcer / complications*
  • Duodenal Ulcer / mortality
  • Duodenal Ulcer / surgery
  • Hematemesis / etiology
  • Humans
  • Middle Aged
  • Peptic Ulcer Hemorrhage / etiology*
  • Peptic Ulcer Hemorrhage / mortality
  • Peptic Ulcer Perforation / complications*
  • Peptic Ulcer Perforation / mortality
  • Peptic Ulcer Perforation / surgery
  • Postoperative Complications / etiology*
  • Retrospective Studies