Surgical management of acute gastric and duodenal stress ulcers

The surgical management of bleeding stress ulcers

The series included 52 patients with acute bleeding stress ulcers of the stomach and duodenum seen at the Mayo Clinic during a 25-year period. All patients underwent operation for control of massive bleeding that was unresponsive to intensive medical therapy. All ulcers were superficial and occurred during clinically stressful circumstances. No patient had a history or findings suggestive of pre-existing peptic ulcer disease or imbibation of ulcerogenic substances. Overall operative mortality was 54%, and this rate seemed to be related to multiple factors acting together; patients with multiple predisposing stress factors and those requiring large transfusion volumes (greater than 17 total units) were at greatest risk of death. Fifty-two patients underwent 60 operative procedures for control of hemorrhage. Of the 60 procedures, 23 (38%) failed to prevent rebleeding. Of the 28 patients who died, six (21%) died of hemorrhage and five (18%) died of hemorrhage as one of many contributing factors. Of eight different procedures performed, near-total to total gastrectomy was the single procedure that was most effective in controlling hemorrhage. The authors support the selection of rapid intervention and generous extirpative surgery once intensive medical measures fail to control hemorrhage.

Choice of operation for acute gastric mucosal hemorrhage. Report of 36 cases and review of literature

The results of operative treatment of thirty-six patients with acute gastric mucosal hemorrhage are presented. Alcohol and surgery/trauma were the most frequent causes, and renal failure, sepsis, or multisystem disease caused most deaths; overall mortality was 44 per cent. Vagotomy-pyloroplasty and vagotomy-resection are compared, and no statistically significant difference in rebleeding, reoperation for bleeding, or mortality is identified.