POSTBULBAR DUODENAL ULCER *

POSTBULBAR duodenal ulcer, as the name implies, is one situated in the duodenum distal to the duodenal bulb. Anatomically, such an ulcer is in the postbulbar part of the first portion, or in the second, third or fourth portion, of the duodenum. Fewer than 150 cases have been reported in the English literature in this century, the largest series being that of 18 cases reported by Swarts and Rice l in 1954. This type of ulcer may be extremely difficult to diagnose, inasmuch as specific diagnostic criteria have not been universally accepted. The purpose of this investigation was to determine in a large series of cases whether ulcers of this nature deserve special recog-nition from both a clinical and a therapeutic standpoint. The position of the ulcer far out in the duodenum may often prevent easy roentgenographic demonstration on routine examination. Anatomists have divided the duodenum into four major components. Roentgenologists agree with this subdivision, but in actual practice they see many normal variations in contour, length and course, especially of the firs