Emergency diagnosis of upper digestive tract bleeding by roentgen examination without palpation (Hampton technic).

Abstract

Gross hemorrhage from the upper digestive tract is a serious and dramatic event. The early recognition of the cause and site of bleeding determines the treatment and may be lifesaving. While the source of the hemorrhage can often be suspected from the history and physical findings, the patient's condition may preclude adequate interrogation or examination. Hemorrhage may occur without symptoms which might offer a clue as to its cause. Moreover, even with a clear-cut peptic ulcer history, it is helpful to know whether the ulcer is gastric or duodenal, since gastric ulcers usually bleed more severely and are more likely to require emergency surgical intervention (1, 2, 14). Recent advances in the medical and surgical management of patients with hemorrhage from esophageal varices (10, 11, 12) and peptic ulcer (8, 9, 15) make it imperative that the source of bleeding be determined during the acute episode. A knowledge of the exact location of the lesion will also be of great help to the surgeon if operation becomes necessary. It is apparent, then, that early roentgen examination in upper digestive tract bleeding merits serious consideration and might serve at least three purposes: (1) as a means of determining the source of hemorrhage for definitive treatment, (2) as a help in selecting the surgical approach should emergency operation prove necessary, and (3) as an index of prognosis. In 1937, Hampton (6) described the use of early roentgen study without palpation in acute bleeding from the upper digestive tract. Few reports concerning evaluation of this method of examination are encountered in the literature (3, 4, 6, 13, 15). Although our experience with the procedure at the Cincinnati General Hospital dates back to 1938, the present report is based only on cases seen between July 1, 1949, and July 1, 1950. This period was selected because all the patients were personally observed by one of us (H. C. K.) and could be studied under uniform circumstances. Technic The gastro-intestinal roentgen examinations are performed as emergency procedures by residents in radiology, who are instructed to avoid palpation and pressure of any sort. The examinations are made with a 200-ma., 100-kv. x-ray unit equipped with spot-film device and rotating anode tubes above and below the table. A 6ounce mixture of barium sulfate and water in equal volumes is used. The procedure, which we call the “Hampton technic,” is as follows: The patient is lifted from stretcher or bed to x-ray table in supine position by means of a draw sheet. About 2 ounces of the barium mixture is given, and the patient is turned on his right side, then back to the supine position. This serves to distribute the barium over the wall of the entire stomach. Multiple non-pressure spot films of the stomach are then obtained. Next, the patient is again placed on his right side until barium is seen to enter the duodenal bulb, after which he is returned to the supine position and rotated toward the left (the Hampton maneuver).