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“Stress” Gastric Mucosal Bleeding: Endoscopy, Pathology and Management C. Sugawa 1,2 , C. E. Lucas 2 , A. J. Walt 2 2Department of Surgery, Wayne State University School of Medicine and Detroit General Hospital pp.1603-1610
Published Date 1971/11/25
DOI https://doi.org/10.11477/mf.1403111491
  • Abstract
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 Modern supportive care which prolongs life in critically ill patients is often complicated by major gastric bleeding. Since 1967, over 300 patients required transfusion for this disease; 38 underwent surgery with 18 deaths. All 38 patients had sepsis, mainly peritonitis and/or pneumonitis. They were analyzed with respect to 1) serial mucosal changes, studied by pre-bleed gastric photography; 2) light (H & E) microscopy of intraoperative biopsies and resected specimen; 3) pre-bleeding acid secretion; 4) preventive and operative management.

 Photographic gastric mucosal chages were present in all 42 patients. These changes consisted of interspersed foci of pallor and hyperemia, red or black based erosions, oozing from mucosal surface, bleeding from superficial erosions and white based erosions. These erosions were located primarily in the body (fundic gland area).

 Histology showed serial changes in the lamina propria consisting of subfoveolar edema, diapedesis, hyperemia, severe mucosal hemorrhage, and finally, mucosal necrosis.

 Gastric hypersecretion (>3 mEq/hr) was present in most patients.

Management

 Ice-saline lavage was unsuccessful in 13 patients and gave only temporary remission in 25 cases. Operative therapy varied with severity of bleeding. Vagotomy and distal gastrectomy was the most successful procedure in preventing rebleeding. Serial photographic and histologic changes were shown. Definition, etiology and plan of management of stress bleeding were discussed.


Copyright © 1971, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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