Radiographic Diagnosis of Prolapsed Redundant Gastric Mucosa into the Duodenum, with Remarks on the Clinical Significance and Treatment

Abstract

Prolapses of redundant or hypertrophied gastric mucosa into the duodenum occur frequently enough that they should be recognized and their clinical significance properly evaluated. Experience in the past few years indicates that the filling defects thus produced occasionally are misinterpreted and confused with those due to duodenal ulcers, duodenitis, or similar disorders. Furthermore, when such prolapses are present, the tendency of some physicians has been to regard the condition as of no clinical significance. In the U. S. Navy, the diagnosis of duodenal ulcer is a serious matter, as it involves decisions regarding promotion, type of duty, or even separation from the service. On the other hand, a man incapacitated by gastric distress from a prolapse of the gastric mucosa, with or without the complications of hemorrhage or obstruction, can be rehabilitated by surgical measures and returned to active duty. Incidence In eleven months there were admitted to a large Naval Hospital over 19,000 patients. On them were made 1,346 successive roentgen examinations of the upper gastro-intestinal tract (Table I): 13 patients were found to have gastric ulcers, 325 patients duodenal ulcers, 17 patients duodenitis, and 14 patients prolapses of the gastric mucosa. No cases of gastric cancer were discovered. Thus, in this group of young and adult men, prolapse of the gastric mucosa occurred as often as gastric ulcer. It should be pointed out that the roentgen diagnosis of duodenal ulcer was not neglected, since it formed 24 per cent of the diagnoses. This high figure should not be construed as representing the incidence among naval personnel, as all patients in whom a peptic ulcer is found or suspected at the medical dispensaries in a large district are sent to this hospital for evaluation and disposition. The 1.04 per cent incidence of gastric prolapse is higher than that given by Rees (19), whose group found this disorder 4 times in 3,000 x-ray examinations, or at another hospital, where it was observed twice in 2,550 x-ray examinations. Melamed and Hiller (14) found only 19 proved cases in the literature, which with their one case made a total of 20 in 1943. Archer (1) states that prolapsing gastric mucosa is not rare, but gives no figures. In my experience, prolapses of the gastric mucosa occur more frequently than is generally recognized. They are overlooked because: first, the examiner is not thinking about them; second, the filling defect produced by the prolapse is confused with that due to a duodenal ulcer or a duodenitis; third, when recognized, they are sometimes passed over and not mentioned. It is our contention that the roentgenologist should make a positive effort to find this disorder, to distinguish it from duodenal ulcer or other duodenal filling defects, and to report its occurrence to the referring physician.