Identification of Cause of Obscure Massive Upper Gastrointestinal Hemorrhage During Operation

Osborne, Michael

doi:10.1001/archsurg.1957.01280180096013

Cited by 3 publications

(1 citation statement)

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“…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). Osborne and Dunphy (1957) have described a most careful routine at laparotomy and insist on a wide gastrotomy, also recomended by Gilchrist and Chunn (1954), Schulenburg, Barnetson, and Jacobs (1956), Spencer and Maloney (1956), Avery Jones (1959). Others inspect the inside of the stomach through a speculum or sigmoidoscope introduced at laparotomy.…”

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%