Current Concepts in the Surgeon’s Treatment of Bleeding Duodenal Ulcer

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TEAM management of the patient experiencing severe upper gastrointestinal hemorrhage is today the rule rather than the exception. Recognition of the value of having a surgeon as well as the internist or family physician in attendance from the onset of bleeding represents the most significant advance in this field in recent years. It not only avoids a possibly fatal delay in operative intervention to have the surgeon on a standby basis, but it has also resulted in educating surgeons to the fact that the vast majority of serious hemorrhages will cease without an operation.

Gastric cooling as a means of achieving temporary control of bleeding is probably the most publicized innovation of the last decade in the management of bleeding. Less dramatic but perhaps of wider value have been several changes in surgical thinking and surgical technic, an example of which is the use of ligation of the base of a bleeding duodenal ulcer, coupled with the simpler and safer vagus transection with pyloroplasty rather than gastric resection.

Gastric cooling. Gastric cooling is to be distinguished from gastric freezing. In gastric cooling, intragastric temperatures of the order of from 6 to 10 C. (43 to 50 F.) are employed; whereas in gastric freezing, the stomach wall is frozen, and intra-gastric temperatures are of the order of from — 10 to —20 C. (14 to —4 F.). Gastric freezing is employed in a few medical centers for the definitive treatment of chronic duodenal ulcer, but it is far from universally accepted. Gastric. . .



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