Surgical Mortality of Massive Hemorrhage from Peptic Ulcer

The problem of massive gastroduodenal hemorrhage, especially from benign peptic ulceration, has been difficult to analyze because of variable statistics and methods of reporting from different centers. Confusion exists because of different modes of therapy, different types of hemorrhage, and different types of patients treated at these various centers. Although the criteria for the definition of massive hemorrhage as outlined by Stewart^1,2 has aided the evaluation of different reports, there still exists a problem in evaluating results, because one cannot ascertain if these patients undergoing emergency surgery are actively bleeding at the time of surgical intervention. The surgical mortality rate in those cases in which active bleeding is present is significantly higher than in patients undergoing urgent surgery for a recent massive hemorrhage.³ No one will disagree that the mortality rate will be lower if the bleeding has subsided at the time of surgery. Gardner and Baronofsky³