BLEEDING GASTRODUODENAL ULCERS - IMPROVED OUTCOME FROM A UNIFIED SURGICAL APPROACH

We have adopted a uniform, aggressive approach to the management of up per gastrointestinal hemorrhage. our protocol consists of admission to a surgical service, endoscopy within 24 hours, and liberal use of int ensive care monitoring. Urgent or emergency surgery is recommended for the following criteria: 1) presence of shock upon admission, 2) resus citation requirements of greater than 4 units of blood; 3) age 65 year s or older; 4) ulcer size greater than 2 cm or with stigmata of recent hemorrhage; or 5) history of a previous admission for an ulcer compli cation. During the period 1986-1990, 66 patients met the criteria for operation. There were 45 males and 21 females with an average age of 5 3.5 years (range, 29-84). Thirty-seven bled from a gastric ulcer and 2 9 from a duodenal ulcer. They were transfused an average of 5.0 units of blood (range, 0-13). There were no hospital deaths, but 11 patients (16.7%) had 12 postoperative complications. We conclude that a unifie d, single team approach to gastroduodenal hemorrhage with expedited wo rk-up and early operation prevents death from this treatable condition .