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A Word of Caution

LLOYD M. NYHUS, M.D.

AMA Arch Surg. 1962;85(2):223.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In a recent communication, Walters and Tama¹ reported the use of an interposed jejunal segment between the gastric remnant and duodenum in a patient with severe postgastrectomy dumping syndrome. The patient was alleviated of his incapacitating symptoms almost immediately. This further corroborates the excellent results reported by Henley^2,3 and Hedenstedt^4,5 of jejunal interposition for relief of this serious postgastrectomy complication.

Walters and Tama¹ mention the risk of anastomotic ulcer following this operative technique. Greater emphasis must be made of this point. The procedure is an ulcerogenic preparation unless a certain precaution is taken. Acid-peptic juice from the gastric remnant pours over the unprotected jejunal mucosa at the proximal anastomosis. At this point, the jejunal mucosa is spatially removed from the protective duodenal chyme. Anastomotic ulcer is very prone to develop. Henley⁶ reported a 17% and Hedenstedt⁷ a 9% stomal ulceration rate in their early . . . [Full Text PDF of this Article]

Author Affiliations
SEATTLE

Associate Professor of Surgery, Department of Surgery, University of Washington.; From the Department of Surgery, University of Washington School of Medicine.

Footnotes
Received for publication Sept. 19, 1961.

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