Bleeding gastroduodenal ulcers: improved outcome from a unified surgical approach.
We have adopted a uniform, aggressive approach to the management of upper gastrointestinal hemorrhage. Our protocol consists of admission to a surgical service, endoscopy within 24 hours, and liberal use of intensive care monitoring. Urgent or emergency surgery is recommended for the following criteria: 1) presence of shock upon admission; 2) resuscitation requirements of greater than 4 units of blood; 3) age 65 years or older; 4) ulcer size greater than 2 cm or with stigmata of recent hemorrhage; or 5) history of a previous admission for an ulcer complication. During the period 1986-1990, 66 patients met the criteria for operation. There were 45 males and 21 females with an average age of 53.5 years (range, 29-84). Thirty-seven bled from a gastric ulcer and 29 from a duodenal ulcer. They were transfused an average of 5.0 units of blood (range, 0-13). There were no hospital deaths, but 11 patients (16.7%) had 12 postoperative complications. We conclude that a unified, single team approach to gastroduodenal hemorrhage with expedited work-up and early operation prevents death from this treatable condition.
Bender
J S
JS
Department of Surgery, Francis Scott Key Medical Center, Baltimore, Maryland 21224.
Bouwman
D L
DL
Weaver
D W
DW
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002985:Clinical Protocols; D004381:Duodenal Ulcer / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010359:Patient Readmission; D010438:Peptic Ulcer Hemorrhage / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology; D013276:Stomach Ulcer / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014628:Vagotomy