The localization of duodenal and prepyloric ulcers; a correlation of radiologic and gastroscopic findings with specimens resected at operation.

Summary 1.In order to estimate the accuracy of the radiologic diagnosis of peptic ulceration in the gastric antrum, the pyloric region, or the first part of the duodenum a comparison was made of the preoperative barium meal examination findings with the findings in the surgically resected specimen in 50 cases. The nature of the operation employed, antroduodenectomy, provided specimens of the area being studied. 2.The presence of an ulcer niche or significant deformity of the duodenal cap, pylorus or antrum was sufficient to make a correct diagnosis of peptic ulcer in 48 of the 50 cases studied, when taken in conjunction with the clinical features of the case. 3.However, ulcer niches were seen in less than half of the patients in whom peptic ulcers were proved to be present. 4.The exact localization of the ulcer site was often not possible on radiologic grounds, the chief difficulty being the location of the pylorus. 5.Multiple ulcers were found in 17, but were not diagnosed in any before resection. 6.The duodenal deformity seen in the barium meal examination may be due to contraction around one or more ulcers which has produced a secondary diverticulum. 7.Antral ulcers may well be present in spite of negative gastroscopic findings. In the present series the gastroscopist often failed to discover them.