Giant Innocent Gastric Ulcer in the Elderly

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Abstract
A series is presented of 78 patients over 60 with giant innocent gastric ulcers. These ulcers measured 3-12 cm in diameter and were responsible for the deaths of 16 patients - 15 from hemorrhage and one from perforation. Symptoms can simulate gastric carcinoma closely. The site of pain may be anywhere in the abdomen or confined to the lower part of either side of the chest or retrosternal region. Failure to appreciate this may be responsible for dangerous delay in diagnosis and treatment. Almost half the patients were admitted to hospital with acute hemorrhage. Perforation occurred in 4. It is uncommon for acute hemorrhage to cease with medical treatment and the mortality of this complication was 37%. Immediate treatment with blood transfusion is advised and resort to surgery should be early rather than late. When a giant ulcer is diagnosed the patient should be admitted to hospital because of the risk of hemorrhage and preliminary medical treatment given. Long term results of medical treatment are poor. About half the ulcers will heal in time but the recurrence rate is high. For this reason surgery is usually advisable after preliminary medical treatment. Twenty-nine patients were treated by elective partial gastrectomy without mortality. Giant ulcers that project clearly from the lesser curve of the stomach are rarely malignant and management should be based on the assumption that they are innocent, unless there is good evidence of malignancy. The most useful evidence of the ulcer being innocent is diminution in size after medical treatment.

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