BLEEDING GIANT GASTRIC-ULCER

Background: A consecutive series of 269 cases of bleeding gastric ulce r were studied prospectively from 1979 to 1993 inclusive. Method: Fift y-five (21%) bad a giant gastric ulcer with a diameter of 3 cm or more . These cases were compared with those with ulcers less than 3 cm in d iameter in terms of clinical details, prognostic factors, urgent opera tion and outcome. Results: Death occurred in 13 cases (5%), urgent sur gery was performed in 75 cases (29%) and there were 11 postoperative d eaths (15%) within a month of surgery. The patient derails in the two groups matched in terms of age, sex distribution, ulcer history, previ ous complication and recent ingestion of analgesics. Clinical comparis on showed that giant ulcer had a poorer prognosis with a higher mortal ity (10 vs 3%, P < 0.01), urgent surgery rate (65 vs 12%, P < 0.01) an d operative mortality (23 vs 11%, difference not significant), Study o f risk factors iri patients with giant ulcer revealed significantly mo re with concurrent illness. shock, anaemia and endoscopic stigmata of recent hemorrhage. Conclusion: More severe bleeding and poorer general condition in tile giant ulcer group stresses the importance of early diagnosis and accurate resuscitation in these patients. Survival depen ds on optimal condition and prompt and timely surgery.