Surgical Management of Massive Acute Upper Gastrointestinal Hemorrhage

Diseases of the Gastrointestinal Tract

“…Acute gastric ulcers were demonstrated in many cases by gastroscopy performed soon after the bleed ing episode. Welch et al (70) report a slight increase in mortality from ulcer hemorrhage treated medically, surgically, or in combination, from the decade 1923 to 1932 to the present. This rise is attributed chiefly to the increasing age of the hospital population and to postoperative -complications; the au thors advise earlier surgery in the elderly patient.…”

Peptic Ulcer With Massive Hemorrhage in the Upper Age Groups

“…Some of those used in the literature have been: a fall in the hemoglobin level to 7 grams per 100 cc. or less, the necessity of five or more blood transfusions during the period of hospitalization, a total circulating red cell mass of less than 60 per cent of normal, or a fall in the red blood count to 3 million or less (1, 2, 4, 5 and 6).…”

“…The problem of massive upper gastro-intestinal hemorrhage secondary to gastric and duodenal ulcers in the upper age groups is becoming more common as the life span of the human being lengthens. Welch and co-workers (1) in 1955 stated that "massive hemorrhage from duodenal ulcer is 15 times more frequent in patients over 70 than it was in 1922 to 1932." Berkowitz and associates (2) found that peptic ulcer of the stomach, duodenum or anastomosis was the cause of acute gastro-intestinal hemorrhage in 75 per cent of 500 cases, and that 43 per cent of these patients were over the age of 50 years.…”

Local Gastric Hypothermia

“…is adequate. 3. For the comfort of the patient and to prevent a marked fall in systemic temperature, a Thermorite blanket is used to supply external heat so that body temperature, monitored by an indwelling rectal thermocouple, does not fall below 95 F. 4.…”