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Vagotomy and Pyloroplasty: An Inadequate Operation for Stress Ulcers?

Vagotomy and Pyloroplasty: An Inadequate Operation for Stress Ulcers? Abstract ACUTE gastroduodenal ulceration occurring in association with major illness,1,2 burns3 (Curling's ulcer), or central nervous system trauma4-6 (Cushing's ulcer) is generally referred to as "stress ulceration." Although the exact mechanism of their development is unknown, the lesions are characteristically shallow ulcers or erosions, often multiple, and without surrounding induration or microscopic evidence of chronic inflammatory response. Most often the erosions occur in the stomach or duodenum,1,3 but they have been described in the distal esophagus,4,5 small bowel,2 and colon.6 In some instances the stress ulcers produce no clinical manifestations or their presence is masked by the primary illness or injury which leads to their development, and they are discovered only at autopsy. More frequently, the sudden onset of upper gastrointestinal hemorrhage or the signs of peritonitis from perforation heralds the development of acute gastroduodenal ulceration. These complications imposed on a patient who is References 1. Fletcher, D.G., and Harkins, H.N.: Acute Peptic Ulcer as a Complication of Major Surgery, Stress, or Trauma , Surgery 36:212-226 ( (Aug) ) 1954. 2. Beil, A.R., Jr.; Mannix, H., Jr.; and Beal, J.M.: Massive Upper Gastrointestinal Hemorrhage After Operation , Amer J Surg 108:324-330 ( (Sept) ) 1964.Crossref 3. Moncrief, J.A.; Switzer, W.E.; and Teplitz, C.: Curling's Ulcer , J Trauma 4:481-494 ( (July) ) 1964.Crossref 4. Cushing, H.: Peptic Ulcers and the Interbrain , Surg Gynec Obstet 55:1-34 ( (July) ) 1932. 5. Wyatt, J., and Khoo, P.N.: Ulcers of the Upper Part of the Gastrointestinal Tract Associated With Acute Damage of the Brain , Arch Path 47:110-118 ( (Feb) ) 1949. 6. French, J.D., et al: Gastrointestinal Hemorrhage and Ulceration Associated With Intracranial Lesions , Surgery 32:395-407 ( (Aug) ) 1952. 7. Enquist, I., et al: Statistically Valid Ten-Year Comparative Evaluation of Three Methods of Management of Massive Gastroduodenal Hemorrhage , Ann Surg 162:550-560 ( (Oct) ) 1965.Crossref 8. Foster, J.H.; Hickok, D.F.; and Dunphy, J.E.: Changing Concepts in the Surgical Treatment of Massive Gastroduodenal Hemorrhage , Ann Surg 161: 968-976 ( (June) ) 1965.Crossref 9. Read, R.C.; Huebl, H.C.; and Thal, A.P.: Randomized Study of Massive Bleeding From Peptic Ulceration , Ann Surg 162:561-577 ( (Oct) ) 1965.Crossref 10. Silen, W., and Moore, F.D.: Surgical Treatment of Bleeding Duodenal Ulcer: A Plea for Caution , Ann Surg 160:778-779 ( (Oct) ) 1964.Crossref 11. Herrington, J.L., Jr., in discussion of Foster, J.; Hickok, D.F.; and Dunphy, J.E.: Changing Concepts of the Surgical Treatment of Massive Gastroduodenal Hemorrhage , Ann Surg 161:968-976 ( (June) ) 1965.Crossref 12. Austen, W.G., and Baue, A.E.: Catheter Duodenostomy for the Difficult Duodenum , Ann Surg 160:781-787 ( (Nov) ) 1964.Crossref 13. Thoroughman, J.; Walker, L.; and Raft, D.: A Review of 504 Patients With Peptic Ulcer Treated by Hemigastrectomy and Vagotomy , Surg Gynec Obstet 119:257-264 ( (Aug) ) 1964. 14. Pevner, A., and Bernheim, A.I.: Acute Postoperative Esophageal Gastric and Duodenal Ulcerations , Arch Path 28:129-140 ( (Aug) ) 1939. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Vagotomy and Pyloroplasty: An Inadequate Operation for Stress Ulcers?

Archives of Surgery , Volume 93 (1) – Jul 1, 1966

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Publisher
American Medical Association
Copyright
Copyright © 1966 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1966.01330010163020
Publisher site
See Article on Publisher Site

Abstract

Abstract ACUTE gastroduodenal ulceration occurring in association with major illness,1,2 burns3 (Curling's ulcer), or central nervous system trauma4-6 (Cushing's ulcer) is generally referred to as "stress ulceration." Although the exact mechanism of their development is unknown, the lesions are characteristically shallow ulcers or erosions, often multiple, and without surrounding induration or microscopic evidence of chronic inflammatory response. Most often the erosions occur in the stomach or duodenum,1,3 but they have been described in the distal esophagus,4,5 small bowel,2 and colon.6 In some instances the stress ulcers produce no clinical manifestations or their presence is masked by the primary illness or injury which leads to their development, and they are discovered only at autopsy. More frequently, the sudden onset of upper gastrointestinal hemorrhage or the signs of peritonitis from perforation heralds the development of acute gastroduodenal ulceration. These complications imposed on a patient who is References 1. Fletcher, D.G., and Harkins, H.N.: Acute Peptic Ulcer as a Complication of Major Surgery, Stress, or Trauma , Surgery 36:212-226 ( (Aug) ) 1954. 2. Beil, A.R., Jr.; Mannix, H., Jr.; and Beal, J.M.: Massive Upper Gastrointestinal Hemorrhage After Operation , Amer J Surg 108:324-330 ( (Sept) ) 1964.Crossref 3. Moncrief, J.A.; Switzer, W.E.; and Teplitz, C.: Curling's Ulcer , J Trauma 4:481-494 ( (July) ) 1964.Crossref 4. Cushing, H.: Peptic Ulcers and the Interbrain , Surg Gynec Obstet 55:1-34 ( (July) ) 1932. 5. Wyatt, J., and Khoo, P.N.: Ulcers of the Upper Part of the Gastrointestinal Tract Associated With Acute Damage of the Brain , Arch Path 47:110-118 ( (Feb) ) 1949. 6. French, J.D., et al: Gastrointestinal Hemorrhage and Ulceration Associated With Intracranial Lesions , Surgery 32:395-407 ( (Aug) ) 1952. 7. Enquist, I., et al: Statistically Valid Ten-Year Comparative Evaluation of Three Methods of Management of Massive Gastroduodenal Hemorrhage , Ann Surg 162:550-560 ( (Oct) ) 1965.Crossref 8. Foster, J.H.; Hickok, D.F.; and Dunphy, J.E.: Changing Concepts in the Surgical Treatment of Massive Gastroduodenal Hemorrhage , Ann Surg 161: 968-976 ( (June) ) 1965.Crossref 9. Read, R.C.; Huebl, H.C.; and Thal, A.P.: Randomized Study of Massive Bleeding From Peptic Ulceration , Ann Surg 162:561-577 ( (Oct) ) 1965.Crossref 10. Silen, W., and Moore, F.D.: Surgical Treatment of Bleeding Duodenal Ulcer: A Plea for Caution , Ann Surg 160:778-779 ( (Oct) ) 1964.Crossref 11. Herrington, J.L., Jr., in discussion of Foster, J.; Hickok, D.F.; and Dunphy, J.E.: Changing Concepts of the Surgical Treatment of Massive Gastroduodenal Hemorrhage , Ann Surg 161:968-976 ( (June) ) 1965.Crossref 12. Austen, W.G., and Baue, A.E.: Catheter Duodenostomy for the Difficult Duodenum , Ann Surg 160:781-787 ( (Nov) ) 1964.Crossref 13. Thoroughman, J.; Walker, L.; and Raft, D.: A Review of 504 Patients With Peptic Ulcer Treated by Hemigastrectomy and Vagotomy , Surg Gynec Obstet 119:257-264 ( (Aug) ) 1964. 14. Pevner, A., and Bernheim, A.I.: Acute Postoperative Esophageal Gastric and Duodenal Ulcerations , Arch Path 28:129-140 ( (Aug) ) 1939.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1966

References