Effect of Double Jejunal Lumen Gastrojejunal Anastomosis upon Production of Ulcers by Histamine

Abstract

Von Eiselsberg 1 introduced the exclusion operation for the treatment of duodenal ulcers. The stomach was severed at its distal end. The pyloric segment was closed and the larger proximal segment of the stomach was anastomosed to the jejunum. Devine 2 advocated the division of the stomach at a more proximal level than in the Von Eiselsberg technic. The intent of both of these operations was to exclude the corrosive action of the acid gastric juice from the duodenum and thus bring about the healing of the duodenal ulceration. The results of these operations proved disappointing since jejunal ulcer developed in a majority of the patients operated by the exclusion methods. The Von Eiselsberg and the Devine procedures were tested in the laboratory. 3 , 4 Jejunal ulcers occurred with regularity when in addition, the alkaline duodenal contents were diverted from the gastrojejunal anastomosis by the Exalto procedure. 5

The senior author has previously published studies concerning the factor of spasm in the etiology of peptic ulcers. 4 , 6 In one of these studies a larger jejunal lumen was created by the anastomosis of two parallel jejunal segments in an anti-peristaltic direction. 6 This newly created and enlarged jejunal lumen was anastomosed to the proximal part of the stomach after the closure of the distal segment according to the method of Devine. At the same time the alkaline duodenal contents were diverted from the gastrojejunal anastomosis by the Exalto procedure. 5 None of the 4 dogs operated in this manner and with a double jejunal lumen developed jejunal ulcers. Of the 12 dogs with the Devine and the Exalto operations and with a single lumen gastro-jejunal anastomosis, 75% developed jejunal ulcers. 6

The present studies have been performed for the purpose of determining the effect of this double lumen jejunojejunal anastomosis upon the production of ulcers by histamine-in-beeswax injection. Varco, Code, Walpole and Wangensteen 7 produced peptic ulcers in 100% of dogs with an intact gastrointestinal tract after daily injections of histamine-in-beeswax. Lannin 8 made extensive experiments with the histamine-in-beeswax preparation to determine which of the various gastrojejunal anastomoses gives the most protection against the jejunal ulcer. He was able to produce jejunal ulcers in 100% of dogs subjected to a gastroenterostomy and to the Devine exclusion operation.