Surgical Management

Surgical treatment is indicated in cases where medical treatment fails to lead to cessation of bleeding. Fortunately, most upper GI hemorrhage will cease with conservative measures. Certain patient characteristics may lead one to consider surgery earlier. For instance, large ulcers with a visible vessel in the base are likely to experience significant rebleeding and probably should be operated on. In addition, patients with significant cardiac disease in whom bleeding would be poorly tolerated may be considered earlier for surgery. Other considerations for early surgery would be an existing contraindication to transfusion (e.g., Jehovah's witness), a difficult cross-match, or flow-dependent cerebrovascular disease.

Selected Reading

1. Nyhus LM, Baker RJ, Fischer JE. Mastery of surgery. 3rd ed. Boston: Little, Brown and Co., 1997.

2. Greenfield LJ, Mulholland M, Oldham KT et al. Surgery scientific principals and practice. 2nd ed. Philadelphia: Lippincott-Raven, 1997.

3. Sabiston DC, Lyerly HK. Textbook of surgery. 15th ed. Philadelphia: WB. Saunders Co., 1997.

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