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A Criticism of Non-surgical Treatment of Hemorrhage Seen from the Side of Surgeons T. Muto 1 1The First Department of Surgery, Niigata University School of Medicine pp.721-725
Published Date 1980/7/25
DOI https://doi.org/10.11477/mf.1403112663
  • Abstract
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 Non-surgical methods of arresting hemorrhage from the digestive tract are performed not only by internists but by surgeons as well. Some of these methods are performed either as a means of diagnosis or emergency procedure preceding surgery. What is written here is therefore more of “opinion” than of “criticism”. If there are some problems that come under the heading of “criticism”, they would be whether or not the time of judgement for surgical indication was pertinent or whether sufficient general management was done during the procedure of nonsurgical control of bleeding.

 The “criticism” is written centering on two or three of the most frequent diseases among those responsible for bleeding from the digestive tract. In chronic gastroduodenal ulcer where blood vessels are exposed, the patient is apt to fall into shock. In gastric ulcer in elderly patients bleeding could be controlled for the time being, but in the long run re-bleeding is frequent. Therefore, in both instances when the patients' general conditions are good, it would be better to have recourse decisively to surgical intervention. Control of hemorrhage by vascular catheterization would be an effective measure in the future. The results of direct operative measure to ruptured varices of the esophagus are so good that it is recommended to check up on the present results and not on those in the past. Injection of vasoconstrictive agents by vascular catheterization or artificial embolism is useful as a preliminary measure before surgery. When the liver is highly impaired, these methods and injection of hardening substances are useful. If subtotal gastrectomy plus vagotomy or total gastrectomy be done in an early stage without scruple, the rate of re-bleeding would be low and so would be mortality. Hemorrhage from early gastric cancer is seen in no small numbers in all the patients with gastric carcinoma. For these patients examination for diagnosis must be done hand in hand with non-surgical control of bleeding.


Copyright © 1980, 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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