In recent years there has been increasing acceptance by internists and surgeons alike of emergency surgical treatment for the patient with uncontrollable massive hemorrhage from peptic ulcer. Progressively, enthusiasm has centered chiefly around the performance of subtotal gastrectomy. It is the purpose of this paper to suggest that the less extensive procedure of directing attention to the bleeding point only is a more rational approach and should result in a lower mortality.
Most authors agree that nonoperative treatment—with adequate blood replacement, early and frequent bland feedings, antacid therapy, and sedation—will effectively control the acute episode in the majority of patients with hematemesis or melena and that surgery should be reserved for those patients whose bleeding is uncontrollable, i. e., those in whom shock persists or recurs despite administration of 3 liters of blood or more a day to maintain the systolic pressure above 100 mm. and the hemoglobin above 8