STRESS ULCERS AND BLEEDING

Massive hemorrhage from acute stress ulceration of the stomach and duodenum is an ominous sign in the patient already suffering from major illness, burns, or central nervous system trauma. An operation is frequently required to control the bleeding, and the high mortality has led some investigators to recommend vagotomy, pyloroplasty, and suture ligation of the bleeding point. There is little question that this procedure can effectively control active hemorrhage and that it represents an operation of lesser magnitude than gastrectomy in a patient already weakened by serious illness or injury. The true merit of an operation recommended for the control of massive hemorrhage, however, depends not only on how effectively it controls the immediate hemorrhage, but also on how well it protects against rebleeding.

A communication in the July Archives of Surgery questions the value of vagotomy and pyloroplasty in the management of bleeding from stress ulcers of the stomach