Emergency treatment of hemorrhagic gastric and duodenal ulcer

Introduction

Hemorrhage is one of the most common serious complication of gastric and duodenal ulcer even so, the knowledge and the usage of new anti-ulcer drugs (H₂-receptor antagonists and inhibitors of the proton-pump enzyme such as omeprazole) and the success of therapy of Helicobacter pylori infection of gastric and duodenal mucosa, have changed the role of surgical treatment of ulcer disease.

Our aim is to describe the evaluation of bleeding peptic ulcer, the indications for surgical treatment and the type of operative procedure or method that it has to be performed.

Patients and methods

From 1987–1992 we had in our clinic 416 patients with severe gastric-duodenal hemorrhage (312 males and 104 females). The average age of the patients was 63 years (range: 20–85 yrs). Analytically we had: 251 (60.3%) patients with duodenal ulcer, 72 (17.3%) with gastric ulcer, 58 (13.9%) with gastric cancer, 27 (96.5%) patients had acute hemorrhagic gastritis and 4 (1%) patients had gastric benign tumors.

Results

In 84 patients we could not manage to control the bleeding (severe hemorrhage) by conservative methods (transfusions of blood, anti-ulcer medication) or/and by using the method of endoscopy. These patients have been operated. The surgical procedures that have been undertaken were: vagotomy and pyloroplasty 43 (51.1%), vagotomy and gastrojejunostomy 23 (27.5%) and gastrectomy 18 (21.4%).

From these patients 78 have cured and 6 died because of the high severity of the bleeding in association with their old age (age >80 years) and their general health status (2 of them had coronary disease and another one was diabetic with respiratory deficiency).

Conclusions

Bleeding as complication of peptic ulcer remains up today very serious factor that increases the morbidity and the mortality. The aim is to avoid operating on all patients who would recover on medical treatment, but to operate on all patients who if treated medically would bleed again to a dangerous extent. Furthermore, if surgical treatment is undertaken, it should be performed at the optimal time and the safest operative procedure should be used, by a highly skilled surgeon. The age and general condition of the patient are important factors to consider. The amount of hemorrhage and the rate of hemorrhage are of prognostic significance.