Original communication| Volume 17, ISSUE 5, P692-696, May 1945

The indications for operation in cases of peptic ulcer from the internist's point of view

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      Many of the problems of peptic ulcer are not capable of solution by exact methods; they remain matters of opinion upon which physicians will differ. The points brought out with reference to indications for operation may be summarized briefly as follows.
      What at first appears to be total pyloric stenosis may in fact be partly due to reversible spasm and edema. Hence, operation should rarely be done until measures to relieve such spasm and edema have failed.
      From the surgical standpoint the great problem of hemorrhage is to recognize that it has become “intractable” before it is too late to save life by operation. Since a first hemorrhage in a young person is rarely fatal one may put off operation longer than in an elderly person with persistent bleeding. Transfusion of concentrated red blood cells may be lifesaving in preparing a patient who has bled severely.
      Cancer develops so rarely in gastric ulcer that prophylactic excision is not usually indicated. However, ulcers apparently benign which fail to heal promptly may in fact be cancer and should be removed by gastric resection.
      With the recognition that peptic ulcer is often a psychosomatic problem, operation will be done less often than formerly for indigestion (without obstruction or hemorrhage), but operation still has a place in refractory cases with insignificant psychiatric symptoms.
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