Gastric hypothermia for massive upper gastrointestinal hemorrhage. Experience with 24 patients and a review of literature.

Abstract

MASSIVE upper gastrointestinal hemorrhage continues to be a serious problem encountered in our aging population. Frequently the bleeding cannot be controlled even by intensive conservative therapy which necessitates an emergency operation on a critically ill patient. Sometimes in the case of severe hemorrhage, an operation must be performed before an accurate diagnosis can be made. Numerous investigators have reported a high mortality for any operation performed under these circumstances. Darin et al observed that 44% of 291 patients with massive hemorrhage caused by peptic ulcer disease required such an emergency operation, with an overall surgical mortality of 25%; the highest mortality occurred in recurrent bleeders and those with the greatest rapid blood loss. 1 In another report, Foster et al described a 28% overall operative mortality for emergency gastroduodenal surgery in the bleeding patient which, in fact, increased to 63% for those patients whose massive upper gastrointestinal hemorrhage began while