Treatment of acute massive hemorrhage in peptic ulcer

Abstract

Acute massive hemorrhage from peptic ulcer is a serious complication, particularly in patients with chronic, callous ulcer. In a series of 108 cases of massive hemorrhage of peptic ulcer in the Lahey Clinic, there were five deaths, a mortality of 4.6 per cent. In the majority of cases the method of treatment employed in acute hemorrhage from peptic ulcer is a conservative régime consisting of rest in bed, morphine in doses large enough to produce adequate sedation, starvation diet for a few days, and then a gradual application of the Sippy régime. Surgical management is employed in a very small group of cases in which there is continuous bleeding from an erosion of a large caliber vessel, uncontrollable by conservative measures. The operation of resection of the stomach with the removal of the ulcer is the operation of choice, provided the patient's condition will permit it. If resection cannot be employed, a more conservative procedure is followed, such as transduodenal ligation of the eroded vessel in duodenal ulcers, or an excision of a gastric ulcer, with or without a gastroenterostomy.