Haematemesis as a Surgical Problem

Bohn, Gordon

doi:10.1136/bmj.2.4628.630

Cited by 15 publications

(6 citation statements)

References 3 publications

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“…Most surgeons prefer a gastric resection or possibly a sleeve resection for acute gastric ulcers. Bohn (1949) and Large (1960) have successfully practised submucosal excision for 23 bleeding acute gastric ulcers since 1946. Avery Jones (1956) suggests that this may be done only in women. There has been much recent concern about the correct procedure when no ulcer or other abnormality is found, the "laparotomie blanche" ofthe Continental authors (Tanner, 1958;Bruce andDudley, 1959, 1960, and others).…”

Section: Discussionmentioning

confidence: 99%

Surgery in Bleeding Peptic Ulcers

Ward‐McQuaid¹,

Pease²,

Smith³

et al. 1960

Gut

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This paper records a study of 400 patients admitted for haematemesis and melaena. Emergency surgery was undertaken on selected patients but the overall mortality increased when more frequent emergency operations were performed in the latter half of the series.The proper management of haematemesis and melaena is a constantly recurring problem. Our material consists of 473 patients admitted for haematemesis and melaena between January, 1953, and July, 1958. Four hundred of these (87%) were for proved or suspected peptic ulceration, and the main object of this paper is to discuss the place of surgery in this group. The overall mortality of the ulcer group was 6.25 %. Ninety-eight (24.5 %) were submitted to emergency surgery. The remaining 73 patients (13 %) bled from causes other than ulcer. The Mansfield hospitals serve a population of some 200,000 in a well-defined area. All patients admitted to hospitals and nursing homes for definite haematemesis and melaena are included and classified according to Avery Jones (1956). ANALYSIS OF RESULTSIn the analysis of results, the ulcer group as a whole is considered first, then all patients in the ulcer series operated on in the acute phase or later. Next comes a summary of other operations done for peptic ulcer over the same period. A more detailed account of the emergency operations (that is within 24 hours of bleeding) in the ulcer group and their results follows. The first 200 and the second 200 of the whole peptic ulcer group are then compared. Finally, there is a short section on the causes of bleeding other than an ulcer, and the emergency operations that were done in this group. (58 %) were diagnosed by radiology or at operation. Duodenal ulcers outnumber gastric ulcers by 159 to 70. The acute lesion group (32 %) refers to those patients in whom radiology failed to show an ulcer three weeks or so after admission. The unclassified group (6 %) refers to incompletely investigated patients with strong presumptive evidence of peptic ulceration. The post-operative group (4 %) followed gastro-enterostomy or partial gastrectomy. The whole series mortality is slightly higher for gastric ulcers (10%) than for duodenal ulcers (8.8 %), although the operative mortality was rather higher for duodenal ulcers. The acute lesion group had a mortality of 4.2%. No necropsy was done on the patient who died in the unclassified group. THE ULCER GROUP AS

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Section: Discussionmentioning

confidence: 99%

Surgery in Bleeding Peptic Ulcers

Ward‐McQuaid¹,

Pease²,

Smith³

et al. 1960

Gut

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“…5. (1956 From this hospital, Bohn (1949) reported his experience of 150 cases of gastro-duodenal haemorrhage treated under his personal care in surgical wards. 135 were of acute or chronic peptic ulcers, 33 (25%) underwent emergency surgery, and the overall mortality was 7.4%.…”

Section: Infectious Mononucleosis Brditijsohmentioning

confidence: 99%

“…The basis for selection in this series was the same as that applied by Bohn (1949) in the first series reported from this hospital. Briefly, surgery may be indicated:…”

Section: Selection Of Patients For Surgerymentioning

confidence: 99%

Gastro-duodenal Haemorrhage as a Surgical Emergency

Large¹

1960

BMJ

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“…While the mortality with medical management can be as low as that achieved by Meulengracht (1935), it is unlikely that a universal surgical approach wiU provide comparable success and achieve wide popularity. In general, surgical intervention has been limited to selected patients (Bohn, 1949;Parsons and Aldridge, 1951;Pedersen, 1951), the best results being achieved by prompt surgery in patients with proved or probable peptic ulcers. As Tanner (1950) has stressed, the criterion for success or failure of a surgical policy is its influence on overall mortality and not the mortality for surgical intervention as such, which depends on the type of risk accepted.…”

Section: Discussionmentioning

confidence: 99%