Controversy in the Indication of Surgical Treatment of Acute Bleeding for Peptic Ulcers in Gastroduodenum

Česká verzia

Authors: P. Zonča ¹; M. Lerch ¹; K. Piš ¹; A. Matušek ¹; P. Kovala ²; M. Kremer ²; Z. Dostalík ²
Authors place of work: Chirurgické a traumatologické oddělení, MN Ostrava, primář: MUDr. Z. Dostalík ¹; I. interní oddělení, MN Ostrava, primář: MUDr. K. Piš ²
Published in the journal: Rozhl. Chir., 2007, roč. 86, č. 6, s. 291-293.
Category: Monothematic special - Original

Summary

Introduction:
Bleeding in the upper part of GI tract is a serious condition requiring careful investigation and adequate treatment. The surgical treatment is irreplaceable in the case of unsuccessful conservative treatments. The timing of a surgical intervention in diagnostic-therapeutic algorithm is still controversial, although there are a lot of identification factors.

Material:
538 patients with bleeding I and IIA according to Forrest classification were hospitalized in surgical ICU in the period from July 2001 till December 2006. There were 310 men and 228 women together.

Result:
34 patients with mortality 17.6% were surgically treated after unsuccessful conservative and endoscopic treatment.

Conclusion:
The early surgical intervention for patients with bleeding from peptic ulcus decreases its mortality. The emergency surgical intervention is necessary for patients when bleeding continues in an adequate conservative treatment or in the excessive recurrent bleeding. It is also necessary when the active bleeding is not endoscopicaly treatable or approachable. The number of emergency surgical interventions can be decreased by effective endoscopical treatment and by stabilization of patients. In the case of the location of bleeding in the back wall of duodenal bulbus or in the location of little curvature and especially in bigger peptical lesions the elective surgical intervention should be concerned because of the high risk of recurrence of bleeding. The mortality rate in emergency surgical intervention for excessive bleeding ranges from 10 till 50% compared with elective operations according to literature.

Key words:
indication – surgical treatment – bleeding – peptic ulcer

Zdroje

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