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Peptic ulcer perforation as the presentation of Zollinger-Ellison syndrome.
Dig Dis Sci. 1991 Jan; 36(1):19-24.DD

Abstract

We examined the characteristics of patients with Zollinger-Ellison syndrome who developed a perforation prior to diagnosis to determine whether any clinical features were useful markers of the syndrome. Of 160 patients with Zollinger-Ellison syndrome, perforation occurred prior to the diagnosis being made in 11 (7%). At surgery, perforations were found in the duodenum in six cases and in the jejunum in five. In no case was tumor identified at emergency surgery, and the diagnosis of Zollinger-Ellison syndrome was made only in the postoperative period when excessive gastric secretions were noted. Neither acid output nor serum gastrin concentration were useful predictors for perforation. The patients, six men and five women, were 27-61 years old (median 48) and one had MEN-1. Three patients had no symptoms prior to the perforation. The other eight had symptoms for 1-15 years, with diarrhea occurring in 45% of the cases. Following the diagnosis of Zollinger-Ellison syndrome, patients were given medication to control gastric acid hypersecretion. Eight patients remained well, but the three patients who had had a partial gastrectomy had a complicated course despite medical therapy. Although features of perforation in Zollinger-Ellison syndrome are not specific, jejunal perforation or perforation associated with a history of diarrhea is suggestive of the diagnosis. Serum gastrin should be measured in every case and a partial gastrectomy avoided.

Authors+Show Affiliations

Digestive Diseases Branch, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

1984999

Citation

Waxman, I, et al. "Peptic Ulcer Perforation as the Presentation of Zollinger-Ellison Syndrome." Digestive Diseases and Sciences, vol. 36, no. 1, 1991, pp. 19-24.
Waxman I, Gardner JD, Jensen RT, et al. Peptic ulcer perforation as the presentation of Zollinger-Ellison syndrome. Dig Dis Sci. 1991;36(1):19-24.
Waxman, I., Gardner, J. D., Jensen, R. T., & Maton, P. N. (1991). Peptic ulcer perforation as the presentation of Zollinger-Ellison syndrome. Digestive Diseases and Sciences, 36(1), 19-24.
Waxman I, et al. Peptic Ulcer Perforation as the Presentation of Zollinger-Ellison Syndrome. Dig Dis Sci. 1991;36(1):19-24. PubMed PMID: 1984999.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peptic ulcer perforation as the presentation of Zollinger-Ellison syndrome. AU - Waxman,I, AU - Gardner,J D, AU - Jensen,R T, AU - Maton,P N, PY - 1991/1/1/pubmed PY - 1991/1/1/medline PY - 1991/1/1/entrez SP - 19 EP - 24 JF - Digestive diseases and sciences JO - Dig. Dis. Sci. VL - 36 IS - 1 N2 - We examined the characteristics of patients with Zollinger-Ellison syndrome who developed a perforation prior to diagnosis to determine whether any clinical features were useful markers of the syndrome. Of 160 patients with Zollinger-Ellison syndrome, perforation occurred prior to the diagnosis being made in 11 (7%). At surgery, perforations were found in the duodenum in six cases and in the jejunum in five. In no case was tumor identified at emergency surgery, and the diagnosis of Zollinger-Ellison syndrome was made only in the postoperative period when excessive gastric secretions were noted. Neither acid output nor serum gastrin concentration were useful predictors for perforation. The patients, six men and five women, were 27-61 years old (median 48) and one had MEN-1. Three patients had no symptoms prior to the perforation. The other eight had symptoms for 1-15 years, with diarrhea occurring in 45% of the cases. Following the diagnosis of Zollinger-Ellison syndrome, patients were given medication to control gastric acid hypersecretion. Eight patients remained well, but the three patients who had had a partial gastrectomy had a complicated course despite medical therapy. Although features of perforation in Zollinger-Ellison syndrome are not specific, jejunal perforation or perforation associated with a history of diarrhea is suggestive of the diagnosis. Serum gastrin should be measured in every case and a partial gastrectomy avoided. SN - 0163-2116 UR - https://www.unboundmedicine.com/medline/citation/1984999/Peptic_ulcer_perforation_as_the_presentation_of_Zollinger_Ellison_syndrome_ L2 - http://www.diseaseinfosearch.org/result/7600 DB - PRIME DP - Unbound Medicine ER -