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Among 70 cases of perforated duodenal ulcers treated by plication, eight were complicated by massive postoperative hemorrhage from a syncronous posterior "kissing" duodenal ulcer. Critical analysis revealed that only signs of gastrointestinal (GI) bleeding preoperatively had predictive value for postoperative hemorrhage. Twenty-four patients had one or more predictive signs, and eight actually bled postoperatively. There was a 50% mortality and 75% additional complication rate for the bleeders. In contrast, the nonbleeders had a mortality and a complication rate of only 18% and 35%, respectively. There was no observed superiority of either surgical or medical treatment for postoperative hemorrhage. In perforated duodenal ulcer with evidence of GI blood loss, an intraoperative search for a posterior kissing ulcer is recommended. If a kissing ulcer is found, an acid-reducing operation and suture ligation of the ulcer is indicated.

The clinical presentation, hospital course, and outcome of duodenal ulcer disease in elderly patients were reviewed from the records of 168 patient admitted to a municipal hospital over a three-year period. All patients had an active duodenal ulcer confirmed by either endoscopy and/or surgery. Patients were separated into one of two groups: an elderly patients group (greater than or equal to 60) and a young group (less than 60). The demographics, past clinical history, symptomatology, physical examination features, admitting laboratory data, hospital course, and outcome of these groups were compared. The elderly group, while having the same duration of acid peptic disease, had significantly less complaints of epigastric pain just prior to admission (P = 0.01) and less alcohol usage (P = 0.03) when compared to the younger patient population. The older patient population on the other hand did have a more complicated course of acute disease characterized by a greater rebleeding (P = 0.004), larger transfusion requirement (P = 0.03), and a more prolonged stay of hospitalization with a higher mortality (P = 0.003).