title: Acute radiological investigation of oesophagus and stomach in the event of massive upper gastro-intestinal tract bleeding.
abstract: Acute radiological investigation of the oesophagus, stomach and duodenum is a routine in patients admitted to the first surgical department of Kommunehospitalet, Copenhagen, with upper gastro-intestinal tract hemorrhage. In the period 1969-1972, 294 patients were admitted with hematemesis and/or melena. The acute radiological study was undertaken in 190 of these patients (65%). Whenever possible, confirmation of the acute primary radiological diagnosis was sought at acute operation, subsequent elective operation, by repeated radiological study, by gastroscopy, or at post mortem. 19 acute investigations were inadequate, and in a further 20 patients no studies subsequent to the acute study were made. There remain 151 patients, and the primary diagnosis could be confirmed in 111 (74%). 45 patients underwent acute operation, and primary diagnosis was confirmed in 66%. The most frequent primary diagnosis was duodenal ulcer (78 of 151 patients), which was verified in 63 instances (81%). In 8% of these patients subsequent definitive diagnosis of gastric ulcer was made, and in 11% no cause of bleeding could be demonstrated. Primary diagnosis of gastric ulcer in 28 patients could be confirmed in 85%. Primary diagnosis of oesophageal varices was made in 9 patients and confirmed in 7 (78%). One patient had a carcinoma of the stomach, and this was also the acute radiological diagnosis. In one patient primary diagnosis of oesophageal ulcer was made, but this could not be confirmed. In 34 patients the acute study failed to point the cause of bleeding, and in 50% of these patients subsequent examination was also non-productive. 26% subsequently evidenced duodenal ulcer; 11% gastric ulcer; 6% carcinoma of the stomach; 3% oesophageal varices; and 3%--one patient--a bleeding vessel in the fundus of the stomach. The acute radiological study was complication free. The place of the study in acute diagnosis of the patient with upper gastro-intestinal tract bleeding is discussed.
mesh_terms: D000208:Acute Disease; D000368:Aged; D004381:Duodenal Ulcer / Q000000981:diagnostic imaging / Q000601:surgery; D004386:Duodenum / Q000000981:diagnostic imaging; D004935:Esophageal Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000601:surgery; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013270:Stomach / Q000000981:diagnostic imaging*; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D013276:Stomach Ulcer / Q000000981:diagnostic imaging / Q000601:surgery; D014456:Ulcer / Q000000981:diagnostic imaging / Q000601:surgery