The surgical management of massive gastro-intestinal hemorrhage due to stress ulcer following surgery.
In this paper, thirty-six cases complicated by gastrointestinal bleeding after various operations were reviewed. The mortality rate was 47.2%. In 20 surgical cases, the mortality rate was 35.0%. Especially in the cases of post-intracranial surgery, a remarkably better result was obtained by surgical than by conservative treatment. With reference to the better results of surgical treatment, we suggested that the surgical indication depended on a stressor due to the original postoperative phase, which induced a stress ulcer. In post-CNS surgery, operative treatment should not be performed in a comatose patients. As regards jaundiced patients, those with low improved bilirubin levels should be preferred to those with infected bile ducts. In cases of abdominal surgery, sepsis and functional failure of the liver and kidney must be taken into consideration. From our clinical experience, subtotal gastrectomy combined with truncal vagotomy appears to be a more satisfactory treatment for stress ulcers than gastrectomy or vagotomy alone.
D000368:Aged; D004379:Duodenal Neoplasms / Q000601:surgery; D005743:Gastrectomy / Q000401:mortality; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000523:psychology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012004:Rectal Neoplasms / Q000601:surgery; D013276:Stomach Ulcer / Q000209:etiology* / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications; D014456:Ulcer / Q000209:etiology / Q000601:surgery