Fundusectomy Prevents Post-Operative Jejunal Ulcer

Abstract

The irritating action of gastric juice, the nutritional state of the animal and the greater susceptibility of jejunal mucosa to irritation by acid (as compared to duodenal mucosa) are the principal factors concerned in the development of jejunal ulcers in dogs prepared by the Exalto-Mann-Williamson technique. To study the relative rôles played by gastric juice and nutrition the following experiments were performed:

Control Series with “Stock Diet.” A group of 42 control dogs were operated by the Mann-Williamson technique and fed a diet consisting of ground meat (parboiled), milk, bread, and cod liver oil. All dogs died with a jejunal ulcer within a period of 17 weeks.

Fundusectomy with “Stock Diet.” Eleven dogs were fundusectomized (three-fourths of fundus removed) and then three weeks later the Mann-Williamson operation was performed. The maximum survival time after the second operation was only 15 weeks, but the incidence of ulcer was only 27 per cent. The dogs lost weight rapidly, having been deprived of the greater part of both gastric and pancreatic digestion. It thus became obviously necessary to feed a diet more easily digested and absorbed.

A Series in which Nutrition was Improved: (Special diet). Twenty dogs were similarly operated and fed a more easily assimilated diet consisting of finely ground cooked meat, wheat and barley flour, dried milk, tomato juice, bonemeal, cod liver oil, fresh whole milk, raw ground pancreas (200 gm. daily), fresh ground liver (200 gm. daily), corn syrup (100 gm. daily) and banana flour. This diet was fed three or four times a (day, some dogs eating as much as from 4 to 6 lbs. daily. Ten of the dogs lost weight from the start; but only three died with ulcer within 17 weeks, the others dying from other causes than ulcer. Nine of the remaining ten survived from 20 to 58 weeks, but died with ulcer. The other dog was anesthetized at 82 weeks and no ulcer was found. Only two of these dogs lost weight appreciably, most of which resulted after the ulcer started to bleed.