IN SPITE of improved diagnostic methods, the majority of patients with acute massive upper gastrointestinal hemorrhage undergo surgical exploration without the cause or site of bleeding established. If at the time of laparotomy, careful inspection and palpation of the upper abdominal viscera also fail to identify the source of hemorrhage, the surgeon may either extend his diagnostic endeavors or undertake empiric therapy. Growing dissatisfaction with the results of "blind" gastrectomy has led to renewed interest in the techniques of operative diagnosis.
Since 1959, we have used a long anterior gastrotomy and direct inspection of the widely opened stomach in an effort to establish the source of upper gastrointestinal hemorrhage before undertaking treatment. In the past six years, 77 massively bleeding patients have required diagnostic exploratory gastrotomy and constitute the basis for this report. In every instance, preoperative diagnostic studies and careful inspection and palpation of the liver, stomach, and duodenum