Unusual localization of visceral pain in peptic ulcer after biliopancreatic diversion.

Marginal ulceration (MU) is a well recognized complication after gastric resection. It develops on the intestinal side of the gastroenteric anastomosis, the possible causes being a too large gastric pouch, inadequate mucosal blood flow, Helicobacter infection or NSAID use. Since May 1976, 2,316 patients underwent biliopancreatic diversion (BPD) for treatment of morbid obesity in our department. In BPD a distal gastric resection is done and the ileum 250 cm proximal to the ileocecal valve is anastomosed to the proximal gastric remnant. MU is an infrequent but annoying complication after BPD. Its incidence in our series is today 3.4%, most ulcers (67%) appearing during the first postoperative year. Stomal ulcer is more frequent in men and is strongly influenced, especially in women, by alcohol ingestion and by cigarette consumption. It usually responds well to medical treatment (94% healing with H2 blocker therapy), and it has no tendency to recur except in smokers.