The present treatment of massive upper gastrointestinal hemorrhage, regardless of etiology, still carries a disturbingly high mortality. Karlson,1 comparing 3 generally accepted methods for the therapy of gastroduodenal hemorrhage, found that nonoperation, immediate operation, and selective operation each had a mortality of 14%. Linton and Ellis2 report that in a series of 65 patients with bleeding esophageal varices secondary to an intrahepatic type of portalbed block, 49% died while preparations for surgery were being made. Peptic disease of the stomach and duodenum and esophageal varices comprise about 80% of the cases of massive acute upper gastrointestinal bleeding.3 Death in these 2 groups is attributable to uncontrollable hemorrhage, postoperative complications, or hepatic coma. Thus, if exsanguinating hemorrhage could be managed and operation delayed until the patient was in better condition, mortality rates would undoubtedly diminish. Local gastric hypothermia, a recently described modality, may help to accomplish this end.
MILLER RE, MOSCARELLA AA, FITZPATRICK HF. Local Gastric Hypothermia. Arch Surg. 1963;86(2):272–275. doi:https://doi.org/10.1001/archsurg.1963.01310080096022
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: