December 1957

Identification of Cause of Obscure Massive Upper Gastrointestinal Hemorrhage During Operation

Author Affiliations

Brookline, Mass.
From the Fifth (Harvard) Surgical Service and the Sears Surgical Laboratory, Boston City Hospital.; Clinical Associate in Surgery, Harvard Medical School; Associate Visiting Surgeon, Fifth (Harvard) Surgical Service, Boston City Hospital (Dr. Osborne). Professor of Surgery, Harvard Medical School; Director of the Fifth (Harvard) Surgical Service and Sears Surgical Laboratory, Boston City Hospital (Dr. Dunphy).

AMA Arch Surg. 1957;75(6):964-971. doi:10.1001/archsurg.1957.01280180096013

Introduction  Many important contributions have been made to knowledge of massive upper gastrointestinal hemorrhage in recent years. The importance of coordination of medical and surgical action and planning by a "team" approach has been stressed by us and by others.1,2 The value of establishing a preoperative diagnosis is self-evident.3 Major contributions in this area have been made by Hampton,4 who reported limited x-ray studies during or shortly after hemorrhage. The study can be helpful, as has been shown by Ritvo, Cotter, and Zamcheck,5 who report the safety and accuracy of complete upper gastrointestinal tract roentgenograms. The importance of liver disease as a complicating factor in diagnosis and prognosis is evident from the studies of Smythe and others.6 The sulfobromophthalein (Bromsulphalein) test has proved particularly useful in screening patients with significant liver disease7 and has been used in connection with esophagoscopy8,9 as a means

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