surgery. These patients fulfilled the criteria of: (a) blood loss of more than I000 ml/24 hr, (b) hematocrit less than 25%, (c) clinical shock due to blood loss, or (d) transfusion of 1600 ml whole blood per 24-hour period. They represented 49.4% of all patients admitted wth gastrointestinal bleeding. The accuracy of preoperative diagnosis increased from 56% to 91.5% following the introduction of fiberoptic endoscopy. The source of the bleeding was duodenal ulcer in 126 patients, gastric ulcer in 11, anastomotic ulcer in 12, bleeding neoplasm in 4, hemorrhagic gastritis in 3, hiatus hernia in 2, and esophageal varices in 20. In the early years, surgical treatment was a conventional partial gastrectomy in patients with duodenal ulcer (67), gastric ulcer (9), anastomotic ulcer (7), neoplasms (4), and hemorrhagic gastritis (2). More recently, simple suture of the bleeding ulcer (66), usually combined with vagotomy and gastric drainage, has been employed and has now become established as the favorite procedure.The morbidity of all operations was high and the mortality rate was 12.8% overall. In the first part of the study, the mortality rate was 15.5%, but, more recently, it has decreased to 8.3% with a change in treatment policy.
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