retrospective study of bleeding chronic peptic ulcer

ABSTRACT

During 22 consecutive months, 731 patients presented with acute upper gastrointestinal bleeding to the Casualty Unit, Kasr Al-Aini Hospital, Cairo University. Emergency endoscopy defined the cause in 660 patients [90.3%]. Bleeding chronic peptic ulcers accounted for 17.6% of the cases [116/660]. Ninety seven patients [14.17%] had bleeding duodenal ulcer, 18 patients [2.7%] gastric ulcer, and in one patient, bleeding was due to recurrent anastomotic ulcer. The mean age was 43.3 years. The male to female ratio was 6.7 1. Past history of a diagnosed ulcer and/or dyspepsia were positive in 79.3% of the patients. Seventy eight patients [67.2%] were treated conservatively, with 11.5% mortality. Emergency and urgent surgery were needed in 38 patients [32.8%], with 18.4% mortality. The incidence of surgery was 29.9% among duodenal ulcer bleeders [29 patients] and was 50% in gastric ulcer bleeding [9 patients]. For duodenal ulcer patients, the operation was vagotomy in 24; together with pyloroplasty in 12, with gastrojejunostomy in 9, and with antrectomy in 3. Three patients had subtotal gastrectomy, and in the remaining 2 patients under-running of the bleeding ulcer alone was done. Operated upon gastric ulcer patients had partial gastrectomy, alone in 8 and together with vagotomy in one. The overall mortality of bleeding peptic ulcer was 16 out of the 116 [13.8%]. However, if aggressive diagnosis, intensive care, planned treatment and timely-decided operative intervention were followed, the mortality could have been lower