WOUNDING, SHOCK AND STRESS LESIONS OF THE UPPER GASTROINTESTINAL-TRACT

This retrospective study included 2532 wounded, of whom 354 (14 per ce nt) were treated in surgical intensive care units. In 32 patients, 1.3 per cent of all admissions, upper gastrointestinal bleeding was detec ted. It occurred on average 8.9 days (3-21 days) after the wounding or surgical procedure in severely injured patients and those treated in intensive care units, respectively (32 of 354 patients, 9.0 per cent). All patients received different analgesic drugs and 17 of a group tha t presented with bleeding were given psychotropic agents as well. The majority of patients (96.3 per cent) were administered Hz-receptor ant agonists as prophylaxis against stress ulcer disease. There was a stat istically significant difference between these patients treated with H -2-receptor antagonists and those on no prophylactic therapy. No stati stically significant difference was found between cimetidine and ranit idine in terms of their efficacy. Endoscopic examination revealed mult iple bleeding gastric and duodenal erosions. The lesions were most com monly located in the corpus of the stomach. In the majority of patient s (56.25 per cent), the haemorrhage stopped spontaneously and rebleedi ng presented in four of 32 (12.5 per cent) patients. Of 354 patients t reated in intensive care units, five (1.4 per cent) had to be operated on because of bleeding arrest. Despite all therapeutic and surgical p rocedures undertaken, five of 32 (15.6 per cent) patients died.