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October 1960

Is "Empiric Gastrectomy" Justified?

Author Affiliations

Chief, General Surgery Service, Martin Army Hospital, Fort Benning, Ga.

Arch Surg. 1960;81(4):529-534. doi:10.1001/archsurg.1960.01300040013003

Very often a patient with massive upper gastrointestinal bleeding is operated upon, and, after thorough exploration including a gastrotomy, no source of the bleeding is found. Many surgeons recommend that a 70% empiric gastrectomy be done in the hopes that the source of the hemorrhage will be found by the pathologist in the removed specimen. Small erosions have been found on some occasions.1 The significance of these erosions is obscure. They are transient and may be found by the gastroscopist in normal control subjects. They are apparently not related to gastric ulcer.21 More often no source of bleeding is seen even after careful examination by the pathologist. However, the patient frequently stops bleeding and makes a good recovery. The logic of doing an empiric gastrectomy has seemed inadequate to some surgeons16 but not to others.17 The following case reports and discussion are presented in an attempt