The patient with severe hemorrhage from the upper gastrointestinal tract presents an urgent and difficult problem, especially as to the choice between conservative medical and direct surgical measures. The authors believe that there is justification for prompt laparotomy when the bleeding is massive, and they recommend that subtotal distal gastric resection be carried out even if exploration fails to locate the source. This operation was done in 21 patients, and in 5 no abnormality of esophagus, stomach, small intestine, or liver could be found. As a group, these 21 patients had the advantage of prompt definitive surgery instead of delay and can face the future with relative certainty that they will be free from subsequent ulcer formation and hemorrhage. A careful diagnostic program is assumed to precede such intervention. There were two deaths in this series. The mortality compares favorably with that reported for similar cases managed conservatively.
Custer MD, Boyd RS, Miller JA. IMPORTANCE OF HIDDEN "PLUS VALUES" IN EMERGENCY RESECTION FOR GASTRIC HEMORRHAGE. JAMA. 1959;170(8):930–934. doi:10.1001/jama.1959.03010080038006
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