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Article: Emergency surgical treatment for nonvariceal bleeding of the upper part of the gastrointestinal tract

TitleEmergency surgical treatment for nonvariceal bleeding of the upper part of the gastrointestinal tract
Authors
Issue Date1991
Citation
Surgery Gynecology And Obstetrics, 1991, v. 172 n. 2, p. 113-120 How to Cite?
AbstractEndoscopic and biochemical data were collected prospectively from 1,530 patients admitted with nonvariceal bleeding of the upper part of the gastrointestinal tract between September 1985 and June 1989. Therapeutic endoscopy was done for 93 patients who underwent emergency surgical treatment for bleeding, subsequently required in 29 patients with seven postoperative fatalities. In contrast, 31 (15.7 per cent) of 198 patients (mortality rate of 9.6 per cent at 30 days) died in the hospital who had undergone emergency operation in whom therapeutic endoscopy had not been performed; data for this latter group is now presented. At admission, a greater likelihood of emergency operation was associated with a systolic blood pressure of 100 millimeters of mercury and endoscopic stigmatas of recent hemorrhage (ESRH) (p<0.001). Rebleeding rates for the presence of fresh blood, active spurting and oozing hemorrhage or visible vessel in an ulcer base were 26.5, 28.9 and 35.9 per cent, respectively. Endoscopic stigmatas were thus associated with an increased risk of rebleeding (p<0.0001) and rebleeding led to a sixfold increase in the mortality rate. Congestive cardiac failure, chronic obstructive airway disease, chronic renal failure and a history of previous malignant disease were each associated with postoperative mortality rates of more than 50 per cent. An increased risk of mortality after emergency operation was related to age (p<0.0001), preoperative (p<0.002) and total (p<0.0001) blood transfusion requirement. Immediate operation after resuscitation and endoscopy was required in 87 patients; 11 deaths (hospital mortality rate of 12.7 per cent and 9.2 per cent at 30 days) occurred in this group compared with 20 fatalities (18.0 per cent) documented in 111 patients (9.9 per cent at 30 days) who underwent surgical treatment for rebleeding. We conclude that age, concomitant medical illness and preoperative and total transfusion requirements are each related to outcome after emergency operations. Such urgent intervention is best avoided if at all possible in patients with severe concomitant medical illness.
Persistent Identifierhttp://hdl.handle.net/10722/172657
ISSN
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorBranicki, FJen_HK
dc.contributor.authorColeman, SYen_HK
dc.contributor.authorPritchett, CJen_HK
dc.contributor.authorCheung, WLen_HK
dc.contributor.authorTuen, Hen_HK
dc.contributor.authorFok, PJen_HK
dc.contributor.authorFan, STen_HK
dc.contributor.authorLai, ECSen_HK
dc.contributor.authorLau, PWKen_HK
dc.contributor.authorMok, FPTen_HK
dc.contributor.authorLam, SKen_HK
dc.contributor.authorHui, WMen_HK
dc.contributor.authorLam, DKHen_HK
dc.contributor.authorTang, APKen_HK
dc.contributor.authorTse, MCKen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2012-10-30T06:24:04Z-
dc.date.available2012-10-30T06:24:04Z-
dc.date.issued1991en_HK
dc.identifier.citationSurgery Gynecology And Obstetrics, 1991, v. 172 n. 2, p. 113-120en_HK
dc.identifier.issn0039-6087en_HK
dc.identifier.urihttp://hdl.handle.net/10722/172657-
dc.description.abstractEndoscopic and biochemical data were collected prospectively from 1,530 patients admitted with nonvariceal bleeding of the upper part of the gastrointestinal tract between September 1985 and June 1989. Therapeutic endoscopy was done for 93 patients who underwent emergency surgical treatment for bleeding, subsequently required in 29 patients with seven postoperative fatalities. In contrast, 31 (15.7 per cent) of 198 patients (mortality rate of 9.6 per cent at 30 days) died in the hospital who had undergone emergency operation in whom therapeutic endoscopy had not been performed; data for this latter group is now presented. At admission, a greater likelihood of emergency operation was associated with a systolic blood pressure of 100 millimeters of mercury and endoscopic stigmatas of recent hemorrhage (ESRH) (p<0.001). Rebleeding rates for the presence of fresh blood, active spurting and oozing hemorrhage or visible vessel in an ulcer base were 26.5, 28.9 and 35.9 per cent, respectively. Endoscopic stigmatas were thus associated with an increased risk of rebleeding (p<0.0001) and rebleeding led to a sixfold increase in the mortality rate. Congestive cardiac failure, chronic obstructive airway disease, chronic renal failure and a history of previous malignant disease were each associated with postoperative mortality rates of more than 50 per cent. An increased risk of mortality after emergency operation was related to age (p<0.0001), preoperative (p<0.002) and total (p<0.0001) blood transfusion requirement. Immediate operation after resuscitation and endoscopy was required in 87 patients; 11 deaths (hospital mortality rate of 12.7 per cent and 9.2 per cent at 30 days) occurred in this group compared with 20 fatalities (18.0 per cent) documented in 111 patients (9.9 per cent at 30 days) who underwent surgical treatment for rebleeding. We conclude that age, concomitant medical illness and preoperative and total transfusion requirements are each related to outcome after emergency operations. Such urgent intervention is best avoided if at all possible in patients with severe concomitant medical illness.en_HK
dc.languageengen_US
dc.relation.ispartofSurgery Gynecology and Obstetricsen_HK
dc.subject.meshAcute Diseaseen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAdulten_US
dc.subject.meshAge Factorsen_US
dc.subject.meshAgeden_US
dc.subject.meshAged, 80 And Overen_US
dc.subject.meshBlood Transfusion - Utilizationen_US
dc.subject.meshChilden_US
dc.subject.meshEmergenciesen_US
dc.subject.meshEsophageal And Gastric Varices - Complicationsen_US
dc.subject.meshEvaluation Studies As Topicen_US
dc.subject.meshFemaleen_US
dc.subject.meshGastrectomyen_US
dc.subject.meshGastrointestinal Hemorrhage - Complications - Mortality - Surgery - Therapyen_US
dc.subject.meshGastroscopyen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPrognosisen_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshRecurrenceen_US
dc.subject.meshRisk Factorsen_US
dc.titleEmergency surgical treatment for nonvariceal bleeding of the upper part of the gastrointestinal tracten_HK
dc.typeArticleen_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid1989114-
dc.identifier.scopuseid_2-s2.0-0026099886en_HK
dc.identifier.volume172en_HK
dc.identifier.issue2en_HK
dc.identifier.spage113en_HK
dc.identifier.epage120en_HK
dc.identifier.isiWOS:A1991EV61100005-
dc.identifier.scopusauthoridBranicki, FJ=7003617514en_HK
dc.identifier.scopusauthoridColeman, SY=25960711100en_HK
dc.identifier.scopusauthoridPritchett, CJ=6603960556en_HK
dc.identifier.scopusauthoridCheung, WL=7202743060en_HK
dc.identifier.scopusauthoridTuen, H=6602991320en_HK
dc.identifier.scopusauthoridFok, PJ=6601913500en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridLai, ECS=36932159600en_HK
dc.identifier.scopusauthoridLau, PWK=7102543485en_HK
dc.identifier.scopusauthoridMok, FPT=6603786245en_HK
dc.identifier.scopusauthoridLam, SK=55424391600en_HK
dc.identifier.scopusauthoridHui, WM=7103196477en_HK
dc.identifier.scopusauthoridLam, DKH=7201749373en_HK
dc.identifier.scopusauthoridTang, APK=7201845800en_HK
dc.identifier.scopusauthoridTse, MCK=36730595900en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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