Results of Emergent Surgery for the Upper Gastrointestinal Bleeding

Abstract

Upper gastrointestinal bleeding is still a major problem requiring emergent treatment. Although the diagnostic and therapeutic role of the endoscopy has been increased, elderly patients with endoscopically uncontrolled bleeding and additional systemic diseases, need surgical treatment. The general properties, modality of surgical treatments, morbidity and mortality of the forty-five patients who had endoscopically uncontrolled bleeding were evaluated. Emergent endoscopy determined active bleeding duodenal ulcer in 17 cases (38%). The site of bleeding couldn't be found in 15 patients (33%) because of massive bleeding, and in 10 patients (22%) there was no focus of bleeding in endoscopic examination. We emergently operated these 10 patients because of bleeding and hypotension recurrence after endoscopy. In 3 cases (%7), bleeding marginal ulcer was found. Sixteen percent of cases had history of using nonsteroid antiinflammatory drugs, 11% was using anticoagulant therapy. Forty-eight percent of the patients had additional systemic diseases. Mean value of preoperative erythrocyte transfusion was 7 units and mean preoperative hemoglobin value was 6.4 g/dl. The most frequently performed operative procedure was bilateral truncal vagotomy and pyloroplasty (38%). The mortality rate was 18%. As a result; the availability of endoscopic intervention in emergent cases, the diagnostic and therapeutic experience of the endoscopist, the age and the systemic diseases of the patients, the amount of blood transfusion are the determinants of the decision of the emergent surgery and type of surgery as well as prognosis.