Document Detail

Stress ulceration requiring definitive surgery after severe trauma.
MedLine Citation:
PMID:  11565768     Owner:  NLM     Status:  MEDLINE    
Despite antiulcer prophylaxis 19 severely injured patients at our institution developed stress ulceration (SU) between 1989 and 1999 requiring surgery for perforation (n = 4) or bleeding (n = 15). A herald bleed (HB) 10.7 +/- 1.2 days after admission, 7.2 +/- 1.2 days before definitive operative therapy, and requiring 7.1 +/- 0.9 units of blood occurred in 93 per cent of patients operated on for bleeding. Bleeding preceded perforation in one patient. Central nervous system damage was part of the injury pattern in 68 per cent of the patients including spinal cord (42%), severe head injury (16%), or both (10%). Forty-two per cent had acalculous cholecystitis found at surgery. Eight patients had vagotomy and antrectomy (VA), and 11 patients had vagotomy and pyloroplasty (VP). VA required more time than VP (255 +/- 41 vs 158 +/- 13 minutes; P = 0.02). One patient (12.5%) rebled after VA versus two (18%) after VP; one patient in each group required reoperation. There was no difference in mortality, length of stay, or intensive care unit stay. A herald bleed preceded recurrent hemorrhage of SU by one week. Spinal cord or head injury increase the risk of SU. More than 40 per cent of patients with SU had acalculous cholecystitis found at operation. VA provides no benefit on rebleeding or reoperation over VP, so anatomical considerations and not rebleed rates should determine the surgical procedure.
B L Zarzaur; K A Kudsk; K Carter; F E Pritchard; T C Fabian; M A Croce; G Minard
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  67     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-09-21     Completed Date:  2001-10-04     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  875-9     Citation Subset:  IM    
Department of Surgery, The University of Tennessee Health Science Center, Memphis, USA.
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MeSH Terms
Aged, 80 and over
Central Nervous System / injuries
Middle Aged
Peptic Ulcer / etiology,  surgery*
Peptic Ulcer Hemorrhage / etiology,  surgery
Peptic Ulcer Perforation / etiology,  surgery
Postoperative Complications
Retrospective Studies
Stress, Physiological / complications*
Wounds and Injuries / complications*

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