Vagotomy and Pyloroplasty

ACUTE gastroduodenal ulceration occurring in association with major illness,¹,²burns³(Curling's ulcer), or central nervous system trauma⁴⁻⁶(Cushing's ulcer) is generally referred to as "stress ulceration." Although the exact mechanism of their development is unknown, the lesions are characteristically shallow ulcers or erosions, often multiple, and without surrounding induration or microscopic evidence of chronic inflammatory response. Most often the erosions occur in the stomach or duodenum,¹,³but they have been described in the distal esophagus,⁴,⁵small bowel,²and colon.⁶In some instances the stress ulcers produce no clinical manifestations or their presence is masked by the primary illness or injury which leads to their development, and they are discovered only at autopsy. More frequently, the sudden onset of upper gastrointestinal hemorrhage or the signs of peritonitis from perforation heralds the development of acute gastroduodenal ulceration. These complications imposed on a patient who is