Effects of Diverting the Gastric Contents to the Lower Intestinal Levels

As a result of much clinical and experimental work, the ulcerproducing effect of the gastric contents on the jejunal mucosa following gastrojejunostomy is well established. Few reports have been published concerning the effects of diverting the gastric contents to lower intestinal levels. This work was designed to study the results of shifting the outlet of the stomach to progressively lower levels from the duodenum to the colon, inclusive. Rienhoff,1commenting on the incidence of jejunal ulcer after gastrojejunostomy, mentioned that it has occurred in as high as 25 per cent of clinical cases. He failed to find marginal ulcers following gastroduodenostomy, and having noted further that spontaneous ulceration of the third or inferior portion of the duodenum does not occur, advocated infrapapillary gastroduodenostomy in preference to gastrojejunostomy, although it is technically more difficult. After a series of experimental results in dogs, Ivy and Fauley2came to the conclusion