Billroth II resection with modified Nissen duodenojejunostomy for duodenal ulcer hemorrhage associated with duodenal stricture.

Between January 1988 and December 1992, six patients presenting with chronic duodenal ulcer disease, long segment duodenal stricture, gross gastric dilatation and Forrest Ia hemorrhage from penetrating posterior duodenal wall ulcer were managed by oblique duodenal transsection, suture ligation of arroded pancreaticoduodenal vessel, classic Billroth II resection, Nissen duodenojejunostomy and a Tomoda valve disconnecting the Nissen anastomosis from the gastroenterostomy, -resulting in a functional "uncut" Roux anastomosis. The procedure was expeditious and safe in this patient population, with an uneventful recovery and satisfactory functional results.