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Stress ulceration requiring definitive surgery after severe trauma
B L Zarzaur1, K A Kudsk, K Carter
1Department of Surgery, The University of Tennessee Health Science Center, Memphis, USA.
The American Surgeon
|September 22, 2001
Summary
Severe injuries increase the risk of stress ulceration (SU) in patients. A herald bleed often precedes major bleeding, and acalculous cholecystitis is common. Vagotomy and antrectomy offer no advantage over vagotomy and pyloroplasty for SU surgery.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Trauma Surgery
Background:
- Stress ulceration (SU) is a serious complication in severely injured patients.
- Despite prophylaxis, SU can necessitate surgical intervention for bleeding or perforation.
- Central nervous system damage and acalculous cholecystitis are associated with SU.
Purpose of the Study:
- To analyze the characteristics and outcomes of surgical management for stress ulceration in severely injured patients.
- To compare the efficacy of vagotomy and antrectomy (VA) versus vagotomy and pyloroplasty (VP) in treating SU.
Main Methods:
- Retrospective review of 19 severely injured patients who underwent surgery for SU between 1989 and 1999.
- Analysis of patient demographics, injury patterns, surgical procedures (VA vs. VP), and outcomes including bleeding, rebleeding, and mortality.
Main Results:
- A herald bleed occurred in 93% of patients operated on for bleeding, preceding surgery by approximately one week.
- Central nervous system damage was present in 68% of patients; 42% had acalculous cholecystitis.
- Vagotomy and antrectomy (VA) took longer than vagotomy and pyloroplasty (VP) but showed no significant difference in rebleeding rates or mortality.
Conclusions:
- Herald bleeds are significant predictors of recurrent SU hemorrhage.
- Spinal cord or head injuries are risk factors for SU.
- Surgical approach (VA vs. VP) for SU should be based on anatomical considerations rather than rebleeding rates, as VA offers no clear advantage.
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