Hemorrhage from Peptic Ulcer: An Analysis of 223 Cases

Abstract

Bleeding from the upper gastrointestinal tract has attracted the attention and aroused the interest of physicians for many years. In the period before the diagnosis of ulcer of the stomach or duodenum could be established by x-ray the existence of such lesions was suspected by certain clinicians and the role of ulcer as the cause of massive hemorrhage from the upper gastrointestinal tract was assumed. Abercrombie!, in 1820, wrote in his text book concerning hemorrhage as follows; quantity of blood brought up is often immense, so that the patient is reduced to the last degree of exhaustion; and yet the disease is not often fatal. This observation by such an early investigator de­ serves our particular attention since it is a viewpoint which is often expressed in some modification on the wards of our hospitals to this day. The purpose of reviewing our experience with cases of proven ulcers with gross and massive hemorrhage has been in part to shed light upon this very point. The prognosis of massive hemorrhage from peptic ulcer is still a debated subject. The material used in this review consists of 223 cases of bleeding peptic ulcer which were observed at the Indiana University Medical Center. The patients were hospitalized in either the Indianapolis General Hospital, the Indiana University Hospitals or the Indianapolis Veterans Administration Hospital. The cases were seen between 1940 and 1950 in the first two in­ stitutions and between 1946 and 1950 in the Veterans Hospital. Cases of peptic ulcer confirmed by x-ray, operation or autopsy only were included. SEVERITY OF HEMORRHAGE Table I shows a classification of all cases according to severity of hemorrhage. Nothing is thought to be more important in the prognosis of a case of bleeding from a peptic ulcer than some estimation of the severity of the hemorrhage. Some semblance of uniformity in classifying such cases in this important regard is necessary. We have accepted the criteria of Fisher and Zuckerman 2 dividing all cases into four classes on the basis of the lowest red blood count and hemo­ globin determination. Even this method allows certain errors, particularly