Subject(s)
Abdominal Cavity/surgery , Electrocoagulation/methods , Gastrointestinal Hemorrhage/prevention & control , Abdominal Cavity/pathology , Adult , Aged , Cost-Benefit Analysis , Electrocoagulation/economics , Electrocoagulation/instrumentation , Humans , Middle Aged , Time Factors , Treatment OutcomeABSTRACT
In 1982-1996 yrs of 8822 patients with ulcer bleeding in 122 (1.4%) it was concurrent with gastroduodenal ulcer perforation. In 34 (27.9%) simultaneous perforation and bleeding were observed, in 88 (72.1%) perforation occurred in 1-7 days after bleeding, in 48 (54.5%) it was concurrent with recurrent bleeding. Postoperative mortality lowered from 25 to 7.1% due to application of the principles elaborated.
Subject(s)
Duodenal Ulcer/complications , Peptic Ulcer Hemorrhage/surgery , Peptic Ulcer Perforation/complications , Stomach Ulcer/complications , Acute Disease , Adult , Aged , Aged, 80 and over , Duodenal Ulcer/surgery , Female , Humans , Male , Middle Aged , Peptic Ulcer Hemorrhage/etiology , Peptic Ulcer Perforation/surgery , Recurrence , Stomach Ulcer/surgeryABSTRACT
Over the period 1982-1996 a total of 8822 patients with ulcerorrhagias were treated in a clinical setting. In 122 (1.4%) patients different variants of association of perforation of the bleeding ulcers (PBU) were recordable. Features of development, course, diagnosis and treatment of PBU patients were studied. Two variants of PBU development were identified: concurrently emerging perforation with ulcer bleeding--in 34 (27.9%) patients; when perforation of the ulcer emerged in 88 (72.1%) in--patients one to seven days following a bleeding event, presenting in 48 (54.5%) with bleeding recurrence, and in 40 (45.5%) patients without the above recurrence against the background of varying degrees gravity of loss of blood. As to PBU localization, 92 (75.4%) patients had the same site (in the stomach--18 subjects, pyloroduodenal region--74 ones), 30 (24.6%) patients developed simultaneously one perforating gastric or duodenal ulcer and some other ulcer bleeding. Analysis of symptoms in PBU and in 474 patients presenting with perforating ulcers without bleeding revealed varying degrees atypicalness of PBU course depending on variants of combination. A symptom complex of lesser PBU sign has been singled out, an algorithm proposed for procedures that might be helpful in making early diagnosis and planning surgical treatment to be done in a timely fashion. The suggested approach enabled the postoperative mortality to be reduced 3.5-fold (from 25% to as low as 7.1%).
