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Massive haemorrhage from gastroduodenal ulcer. A series of 149 casees operated on
Insights
This study on massive gastrointestinal bleeding found that surgical outcomes for gastric ulcers (GU) and duodenal ulcers (DU) differ. Emergency surgery for DU had higher mortality, while semi-emergency surgery showed better results for both GU and DU.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Medicine
Background:
- Massive hemorrhage from gastroduodenal ulcers presents significant clinical challenges.
- Effective surgical management strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To analyze surgical outcomes for massive hemorrhage from gastric ulcer (GU) and duodenal ulcer (DU).
- To compare emergency versus semi-emergency surgical approaches for gastroduodenal bleeding.
- To recommend specific surgical procedures based on patient risk and ulcer type.
Main Methods:
- Retrospective analysis of 149 patients undergoing surgery for massive gastroduodenal hemorrhage.
- Patients divided into emergency (70) and semi-emergency (79) groups.
- Surgical procedures included vagotomy with antral resection or pyloroplasty for DU, and classical resection for GU.
Main Results:
- Operative mortality was 14% in the emergency group and 2.5% in the semi-emergency group (overall 8.0%).
- Recurrence of bleeding occurred in 5.4% of patients, with a 3.4% mortality rate from recurrence.
- Gastric ulcer (GU) was the cause of bleeding in 67% of emergency cases and 30% of semi-emergency cases; duodenal ulcer (DU) was 26% and 63%, respectively.
Conclusions:
- For "good risk" patients with bleeding duodenal ulcer (DU), vagotomy with antral resection is recommended.
- For "poor risk" patients with bleeding DU, vagotomy with pyloroplasty is advised.
- For bleeding gastric ulcer (GU), antrectomy is recommended for "good risk" patients; excision with vagotomy and pyloroplasty for high located ulcers or "poor risk" patients.
Abstract:
A series of 149 patients operated on for massive haemorrhage from gastroduodenal ulcer is presented. The patients were divided into two groups, emergency (70 patients) and semi-emergency (79 patients). In the emergency group the cause of bleeding was GU in 67% and DU in 26%; in the semi-emergency group the corresponding figures were GU 30% and DU 63%. In DU vagotomy + antral resection or pyloroplasty were the usual procedures. GU patients usually underwent a classical resection. The operative mortality rate in the emergency group was 14% and in the semi-emergency group 2.5%. In the whole series the mortality rate was 8.0%. Bleeding recurred in 8 patients (5.4%) and of these eight, five died. The causes of death and the postoperative complications were analysed. In the treatment of massively bleeding duodenal ulcer vagotomy + antral resection is recommended in the case of "good risk" patients and vagotomy + pyloroplasty in the case of "poor risk" patients. For treatment of bleeding gastric ulcer, the procedure recommended with "good risk" patients is still antrectomy, but in cases where the ulcer is situated high up near the cardia and for "poor risk" patients, excision, vagotomy and pyloroplasty should be carried out.