Springer Online Journal Archives 1860-2000
Summary A series of 421 patients with acute bleeding ulcer has been studied. The role of emergency gastrectomy in lowering mortality has been considered. Patients bleeding massively (that is, at a rate which will require the replacement of 3000 cc. or more of whole blood in a 24-hour period) have a very high mortality rate. Emergency gastrectomy performed on such patients is of benefit in lowering the mortality even if the operation is attempted after the patient has already required and received 3000 cc. of blood. Patients losing blood at a rate requiring replacement of 3000 cc. per 48 hours also have a high mortality. In this group emergency gastrectomy will lower the mortality greatly even if performed after the patient has required 3000 cc. of blood. Patients with bleeding ulcer who have an additional serious complicating illness, such as severe heart disease, cirrhosis of the liver, severe burns, or head trauma are much less able to tolerate severe blood loss. These patients should have emergency gastrectomy at a stage in their clinical course much earlier than should the otherwise healthy person with bleeding ulcer. Patients who, except for the acute bleeding ulcer, are in good health and are not bleeding massively tolerate the blood loss very well. The mortality in this group is lower than that of patients given emergency gastrectomy.
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