CLINICAL AND RADIOLOGICAL FEATURES OF PEPTIC ANASTOMOSIS ULCERS IN ZOLLINGER-ELLISON SYNDROME

Abstract

The X-ray method of examination is of leading importance in the recognition of peptic anastomosis ulcers. Despite the fact that the radiological signs of peptic ulcers of the jejunum are described in sufficient detail, certain difficulties are presented in the interpretation of the data obtained due to the gross deformation of the studied department, as well as various shadow formations simulating the symptoms of an ulcerative niche. Purpose of the work. Therefore, the aim of the work was to identify clinical and radiological patterns in Zollinger-Ellison syndrome. Results. The results of the examination of 24 patients with Zollinger-Ellison syndrome were analyzed. All patients had a pain symptom. In 58% cases it was dull pain, in 42% cases - acute. In 84% patients, the localization of pain corresponded to the epigastric region. Vomiting was detected only in 29% cases. The light gap was absent in 9 patients, in 15 patients it lasted from 7 months to 5 years. Free hydrochloric acid in the range of 40-60 titer. units were observed in 8 patients, in other cases within 61-150 titers. units. Gastrointestinal bleeding occurred in 14 patients. 22 patients underwent surgical interventions for the recurrence of peptic ulcers of the jejunum, with 10 resection and 12 stem vagotomy. Endoscopy was performed in 11 patients, an ulcer was detected in 6. During X-ray examination, an ulcerative niche was detected in 22 (92%) patients, and in one case three ulcerative niches were detected. The majority of patients (20 - 83%) had niches more than 2 cm in diameter, and only two had niches of 1.0 and 1.5 cm in size. Cicatricial and ulcerative deformity was found in all patients, and most often (19 cases) - I and II degrees. Conclusion. Thus, in patients with Zollinger-Ellison syndrome, along with its typical clinical manifestations, there were cases of atypical course - a mild pain symptom, no bleeding, low acidity figures. The sizes of ulcers were mostly large, but there were cases when there were small ulcers (1.0-1.5 cm in diameter). Giant ulcers have been identified in patients with low acidity figures. Such atypical cases can make it difficult to recognize Zollinger-Ellison syndrome.