PMID: 18732506Apr 1, 1962Paper

GASTRODUODENAL HEMORRHAGE: SURGICAL MANAGEMENT.

California Medicine
A M DESMOND

Abstract

Two thousand five hundred forty-five cases of upper gastrointestinal tract hemorrhage were studied especially with a view to determining the indications for urgent surgical treatment. Decisions as to whether and when to operate were as follows:Immediate operation for patients over 50 years with a good history of ulcer and a severe initial bleed. Operation after the first repetition of bleeding in patients (1) over 50 with a good history and a mild initial bleed, (2) over 50 with inconclusive history but severe initial bleed, (3) under 50 with a good history and a severe initial bleed. In all other cases, operation was used only if conservative treatment failed. Absolute indications for operation were (a) association with perforation, (b) association with stenosis, (c) persistence of severe ulcer pain after hemorrhage, (d) continuous bleeding. Since operation is to be avoided if possible in cases of esophagitis, erosive gastritis and small acute or subacute ulcers, emergency gastroscopy has valuable uses. Where operation is deemed necessary and no obvious lesion found at laparotomy, blind gastrectomy appears to be the most satisfactory procedure. The mortality rate associated with upper gastrointestinal tract bleeding in patient...Continue Reading

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