Synonyms

Round duodenal ulcer; Ulcus duodeni pep-ticum (Leube).

Definition

A defect in the mucous membrane of the duodenum.

Etiology

The etiology of duodenal ulcer corresponds with that of gastric ulcer. It is undoubtedly caused, as in the stomach, by the action of the acid gastric juice upon the duodenal mucosa, the vitality and nutrition of which have been previously impaired. Such conditions occur as a result of circulatory derangements of various kinds. Thus, affections of the lungs and heart or of the liver, an atheromatous state of the duodenal artery may be the positive factors in disturbing the circulation of the mucous membrane. Burns of the skin are an etiological factor which, while not operative in gastric ulcer, is of great importance in duodenal ulcer. After extensive scaldings of the skin, quite often one or several duodenal ulcers appear. According to Mayer 1 these ulcers develop from seven to fourteen days after the burn, very seldom much sooner. The primary cause of these ulcers is not yet known. The toxic theory which is the most plausible has been discussed above.

Duodenal ulcer is much less frequent than gastric ulcer.

1 Mayer. Annal. de la Soc. de Med. d'Anvers, 1865.

Willigk 1 found it twice in sixteen hundred autopsies. According to this writer, there are thirty-eight gastric ulcers to one duodenal ulcer. According to Starke, 2 however, the ratio is twelve to one. Kraus3 found that the frequency of duodenal ulcers varies in different countries in a similar manner as does gastric ulcer, the northwestern part of Europe having the highest percentage, while it is but rarely met with in the eastern part. In Kraus experience duodenal ulcer most frequently occurs in persons between thirty and sixty years of age. Next in frequency comes the very early age (one to ten, and especially infancy). This is another point of difference between gastric and duodenal ulcers, for the former hardly ever occur in children. With regard to the distribution of duodenal ulcer among the sexes, Kraus found it much more prevalent among the male than among the female sex, the relation being ten to one. According to Lebert,4 however, the proportion is only four to one. This again is another point of difference in the etiology of duodenal and gastric ulcers, for the latter, as is well known, are much more frequently encountered in women than in men (two to one).

Morbid Anatomy

A duodenal ulcer resembles in most particulars a gastric ulcer. It is a defect of the mucous membrane having an oblong and oval contour and extending into the depth of the mucosa in form of a terrace or funnel. The ulcer presents an irregular shape only in those instances in which several ulcers have coalesced, thus forming one large defect. The size of the ulcer varies from that of a lentil up to that of a dollar. The margins are usually smooth and overlapping, the latter being especially the case in chronic affections. The base of the ulcer is formed either by thin layers of the remaining intestinal wall, or, if perforation has taken place, by adhesions with neighboring organs.

1 Willigk: Prager Vierteljahresschr., 1833.

2 Starke: Deutsche Klinik, 1870.

3 J. Kraus: "Das perforirende Geschwur des Duodenum," Berlin, 1865. 4 Lebert: "Die Krankheiten des Magens," 1878.