Abstract Of 796 patients admitted with upper gastrointestinal bleeding during a five-year period, 156 (20%) had erosive gastritis. Vigorous nonoperative treatment stopped bleeding in 117 (75%): emergency operation was required in 39 (25%). In 24 of these 39 patients (group A), subtotal gastric resection with truncal vagotomy was performed. In the remaining 15 patients (group B), the operation was limited to pyloroplasty, truncal vagotomy, and multiple suture ligation. These patients were, on the average, 20 years older than the patients in group A, and 12 had life-threatening preoperative problems. (Only four of the group A patients had life-threatening preoperative problems.) The operative mortality in group A was 42%, with rebleeding occurring in 33%. In group B, only 17% rebled and the operative mortality was 45%. Survival in the two groups was similar, even though those patients in group B were more critically ill. The less radical procedure may often be the best choice in the high-risk and elderly patients who bleed massively and in whom immediate salvage of life is the main issue. References 1. Stremple JF, Mori H, Lev R, et al: The stress ulcer syndrome . Curr Probi Surg April 1973, pp 17-19. 2. Katz D, Siegel H: Erosive gastritis and acute gastrointestinal lesions . Prog Gastroenterol 1:67-96, 1968. 3. Artz C, Fitts C: Gastrointestinal ulcerations associated with central nervous system lesions and with burns . Surg Clin North Am 46:309-317, 1966. 4. Rosenkrantz J, Bartlett M: Hemorrhage from gastritis: An analysis of 44 proven cases . Ann Surg 153:617-624, 1961.Crossref 5. Elliott DW, Hartle R, Marshall F, et al: Response to transfusion as guide in management of upper gastrointestinal hemorrhage . Arch Surg 77:386-395, 1958.Crossref 6. Kelley HG, Grant GN, Elliott DW: Massive gastroduodenal hemorrhage . Arch Surg 87:6-12, 1963.Crossref 7. Menguy R, Gadacz T, Zajtchuk R: The surgical management of acute gastric mucosal bleeding: Stress ulcer, acute erosive gastritis, and acute hemorrhagic gastritis . Arch Surg 99:198-208, 1969.Crossref 8. Noer R: Gastrointestinal tract hemorrhage . Curr Probi Surg March 1964, p 35. 9. Drapanas T, Woolverton W, Reeder J, et al: Experience with surgical management of acute gastric mucosal hemorrhage . Ann Surg 173:628-640, 1971.Crossref 10. Pruitt B, Foley F, Moncrief J, et al: Curling's ulcer: A clinical-pathologic study of 323 cases . Ann Surg 172:523-539, 1970.Crossref 11. Gilchrist R, de Peyster F: The surgical management of massive postoperative hemorrhage . Ann Surg 147:728-732, 1958.Crossref 12. Lucas C, Sugawa C, Friend W, et al: Therapeutic implications of the gastric defense mechanism in stress patients . Am J Surg 123:25-34, 1972.Crossref 13. Taylor PC, Loop FD, Hermann RE: Management of acute stress ulcer after cardiac surgery . Ann Surg 178:1-5, 1973.Crossref 14. Sullivan R, Waddell W: Accumulated experience with vagotomy and pyloroplasty for surgical control of hemorrhagic gastritis . Am J Surg 116:745-754, 1968.Crossref 15. Sullivan RC, Rutherford RB, Waddell WR: Surgical management of hemorrhagic gastritis by vagotomy and pyloroplasty . Ann Surg 159:554-562, 1964.Crossref 16. Scott W, Sawyers J, Gobbel W, et al: Definitive surgical treatment in duodenal ulcer disease . Curr Probi Surg October 1968, p 42. 17. Nagel G: The nature and treatment of stress ulcers . Calif Med 112:19-25, 1970. 18. Kirtley J, Scott H, Sawyers J, et al: The surgical management of stress ulcers . Ann Surg 169:801-809, 1969.Crossref 19. Day S, MacMillan B, Altemeier W: Curling's Ulcer: An Experiment of Nature , Springfield, Ill, Charles C Thomas Publisher, 1972. 20. Goligher JC: An overall view of the surgical treatment of duodenal ulcer . Adv Surg 8:1-27, 1974. 21. Nylander G, Olerud S: The vascular pattern of the gastric mucosa of the rat following vagotomy . Surg Gynecol Obstet 112:475-480, 1961.
Archives of Surgery – American Medical Association
Published: May 1, 1975