Emergency Surgery in Bleeding Peptic Ulcer

Economou, G; Ward-McQuaid, Neil

doi:10.1177/003591577306600808

Cited by 1 publication

(2 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our cross-over study (Economou & Ward-McQuaid 1971), measuring the biliary pressure after operation by T tube, there was a high rise of biliary pressure with morphine, compared with the minimal effect of pentazocine; pethidine comes between. Without a T tube pentazocine seems a wise choice of analgesic, unless antispasmodics are given.…”

mentioning

confidence: 67%

See 1 more Smart Citation

Early Postoperative Abdominal Complications and Reoperations after Gallbladder, Colonic and Gastric Surgery [Abridged]

Ward‐McQuaid

1977

Proceedings of the Royal Society of Medicine

View full text Add to dashboard Cite

The late Arthur Dickson Wright, after one of his rare postoperative complications, once said 'This has never happened to me before'. But sooner or later it does happen, either to patients operated upon by yourself, or under your care. Most surgeons ofexperience have seen, for example, patients in whom a drain or swab has been lost.The incidence of these problems is greater the further one looks back, and where there are poor facilities, and inadequate staff, both in numbers and training. Hospital results are worse than the personal figures, or those from specialist units.The statistics that follow concern early postoperative complications and reoperations after colonic, gallbladder and gastric operations in the Mansfield Group of Hospitals, Nottinghamshire, England. CholecystectomyMortality: In the 1950s there was a mortality of 2.4 % for all cholecystectomies, increasing steeply with age up to 12.8 %; with duct explorations it was 7.6 %. These figures are now much improved.Approximately a third of the deaths were from intraabdominal causes, as were those in 2500 cholecystectomies in the Trent Region in 1975, with a mortality of 1.6 %.Duct injury: We have to admit to 7 major duct injuries in over 3400 cholecystectomies since 1954. Not only this, but 4 of these were not recognized at operation and diagnosed only by deepening jaundice, or a persistent biliary leak.At the second operation there was a tie around the common hepatic duct in one; the operative cholangiogram had showed a good flow into the duodenum but, not surprisingly, none to the liver. The other injuries occurred before operative cholangiography. At the second operation, part of the common duct had gone in 2 cases. In the fourth case, there were two thread ties around the common bile duct, which curiously had not been divided between them. Excision with catgut resuture over a distal T tube gave a good result. All but this last patient required at least two further operations. One I repaired myself, with a good postoperative cholangiogram; at the third operation six months later, 5 cm of common duct had fibrosed across, presumably due to a damaged blood supply; an end-to-end anastomosis by Mr J Lytle gave an excellent result.Three more injuries were recognized at operation (one each of the right hepatic, common hepatic and common bile duct) and repaired over a distal T tube: 2 required further operation.No duct was cut by a consultant, and 4 out of 7 of these injuries occurred in the first third of the series. All the operators came from east of Corfu and west of New Zealand, and were experienced registrars working in twin theatre with a consultant in the other. Five of the 7 patients required at least 2 operations.Biliary leaks: There were 15 further significant biliary leaks without apparent major duct injury or later surgery. Eleven patients had had a T tube; one with delirium tremens avulsed his, and in another the tube was of the progressively stiffening polyvinyl type that was popular for a while. Biliary peritonitis occurred in 6, and 5 died. T...

show abstract

mentioning

confidence: 67%

“…Emergency operations for bleeding due to suspected ulcer: The early postoperative complications of gastric surgery are well illustrated by our updated series of 443 emergency operations for bleeding due to suspected ulcer (Economou & Ward-McQuaid 1973).…”

Section: Gastric Operationsmentioning

confidence: 99%

Early Postoperative Abdominal Complications and Reoperations after Gallbladder, Colonic and Gastric Surgery [Abridged]

Ward‐McQuaid

1977

Proceedings of the Royal Society of Medicine

View full text Add to dashboard Cite

show abstract

Emergency Surgery in Bleeding Peptic Ulcer

Abstract: Emergency surgery in bleeding peptic ulcer remains a problem: not only when to operate, but what to do. This short paper is confined to what is done after the abdomen is open, and its effect on both operation and whole series mortality, and on further bleeding after operation.

Cited by 1 publication

References 4 publications

Early Postoperative Abdominal Complications and Reoperations after Gallbladder, Colonic and Gastric Surgery [Abridged]

Early Postoperative Abdominal Complications and Reoperations after Gallbladder, Colonic and Gastric Surgery [Abridged]

Contact Info

Product

Resources

About