Alimentary Bleeding of Obscure Origin

Jones, F. Avery; Read, A. E.; Stubbe, J. L.

doi:10.1136/bmj.1.5130.1138

Cited by 40 publications

(7 citation statements)

References 16 publications

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“…In two cases a portocaval anastomosis was performed and in a further two, transection of the stomach was carried out. (Avery Jones et al, 1959;Cates, 1959). Whereas over half their cases with haematemesis were caused by peptic ulceration, this association was found in only 18 % of our cases.…”

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confidence: 50%

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Upper gastrointestinal haemorrhage in the non-European

Grieve¹,

Cooper²,

Fraser³

et al. 1961

Gut

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, is presented. The commonest cause was found to be acute gastritis and gastric erosion. These cases were more common in males and usually followed on an alcoholic bout. These were in the main mild. Twenty-five cases associated with peptic ulceration were found, and the lesion occurred more commonly in males under the age of 40. Duodenal ulcer was commoner than gastric ulcer. The incidence of haematemesis with peptic ulceration appears to be on the increase, the cause of which is not known. Cirrhosis of the liver is a frequent cause of haematemesis and carries a high mortality.

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contrasting

confidence: 50%

“…The difficulties of diagnosis and treatment of cases of gastrointestinal haemorrhage in the European have been well documented (Avery Jones, Read, and Stubbe, 1959). The problem is much greater in the non-European patient as the haemorrhage is usually the sole presenting feature, and clinical examination is in the majority of cases negative.…”

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confidence: 99%

Upper gastrointestinal haemorrhage in the non-European

Grieve¹,

Cooper²,

Fraser³

et al. 1961

Gut

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“…The presence of a peptic ulcer does not necessarily imply that it is the site of the haemorrhage which may for example arise from a co-existent acute gastric erosion (Bogoch, 1963). Initially radiologically negative cases may at some later date display a duodenal ulcer (Jones, Read & Stubbe, 1959) but the assumption is not definite that the ulcer was present on the occasion of the haemorrhage. The practice of Forty (1964Forty ( , 1965 of submitting the gastrectomy specimen routinely for histological examination has led him to conclude that the changes of chronic gastritis are consistently present in gastric and duodenal ulcer and he states that the bleeding arises from microscopic erosions as often as it does from an ulcer; he considers that failure to appreciate this aspect is a consequence of radiography having focused undue attention on the ulcer itself.…”

Section: Discussionmentioning

confidence: 99%

The later clinical course of haematemesis

Shafar

Midgley

1969

Postgraduate Medical Journal

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Summary A study was conducted on the natural history of haematemesis in patients with peptic ulcer and in those with negative radiological examination, the bleed having occurred at least 5 years previously; excluded were those who had undergone emergency or interim surgery. No significant difference was found in the average severity of the bleed between the ulcer and non-ulcer groups, which were comparable in age-distributions. Routine follow-up after the haemorrhage was discontinued following correction of the post-haemorrhagic anaemia; the present haematological status was found to be satisfactory in the very great majority and it appears that the acute bleed bears little if any relationship to the process of chronic blood loss. Physical examination and liver function tests revealed no evidence of delayed hepatic damage ensuing as a consequence of transfusion. Recurrent haemorrhages occurred in similar proportions in the ulcer and non-ulcer groups; they revealed no particular time interval or features of significant distinction from those of the initial bleed. Persistence of dyspepsia showed no correlation with a bleeding tendency. There is a preponderance of blood group O in the ulcer and non-ulcer bleeders. The radiological presence of a peptic ulcer does not necessarily indicate that this is the source of the bleeding and it is suggested that the comparable features of the select group of ulcer cases of our series and the non-ulcer cases offer support to the view that the origin of the bleed in a fair proportion of instances is common to the two groups; the possibility of a derangement of the microvasculature as the operating mechanism is mooted.

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“…The failure rate has been of the order of 15-33 % in some large series (Birke and Engstedt, 1956;Jones et al, 1959;Berkowitz, 1963). At operation the source of bleeding often remains obscure (Retzlaff et al, 1961).…”

Section: Introductionmentioning

confidence: 99%

Severe Gastrointestinal Haemorrhage: Haemangiomata Demonstrated by Selective Visceral Arteriography

Ashby¹,

Mott²,

Starer³

1968

BMJ

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Selective visceral arteriography was found to be invaluable in the management of two cases of severe gastrointestinal haemorrhage associated with cavernous haemangiomata (a large gastric haemangioma and a small jejunal haemangioma). It is suggested that arteriography may be indicated in cases where a previous laparotomy has not shown the cause of bleeding, when the patient's general condition precludes a prolonged operation, and when superficial haemangiomata are found.

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Alimentary Bleeding of Obscure Origin

Cited by 40 publications

References 16 publications

Upper gastrointestinal haemorrhage in the non-European

Upper gastrointestinal haemorrhage in the non-European

The later clinical course of haematemesis

Severe Gastrointestinal Haemorrhage: Haemangiomata Demonstrated by Selective Visceral Arteriography

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