Massive haemorrhage from gastroduodenal ulcer. A series of 149 casees operated on.

A series of 149 patients operated on for massive haemorrhage from gastroduodenal ulcer is presented. The patients were divided into two groups, emergency (70 patients) and semi-emergency (79 patients). In the emergency group the cause of bleeding was GU in 67% and DU in 26%; in the semi-emergency group the corresponding figures were GU 30% and DU 63%. In DU vagotomy + antral resection or pyloroplasty were the usual procedures. GU patients usually underwent a classical resection. The operative mortality rate in the emergency group was 14% and in the semi-emergency group 2.5%. In the whole series the mortality rate was 8.0%. Bleeding recurred in 8 patients (5.4%) and of these eight, five died. The causes of death and the postoperative complications were analysed. In the treatment of massively bleeding duodenal ulcer vagotomy + antral resection is recommended in the case of "good risk" patients and vagotomy + pyloroplasty in the case of "poor risk" patients. For treatment of bleeding gastric ulcer, the procedure recommended with "good risk" patients is still antrectomy, but in cases where the ulcer is situated high up near the cardia and for "poor risk" patients, excision, vagotomy and pyloroplasty should be carried out.