This paper is only available as a PDF. To read, Please Download here.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The Indications for Operation in Cases of Uncomplicated Peptic Ulcer.Surgery. 1937; 2: 710
- The Intractable Duodenal Ulcer: Evaluation of Surgical Procedures.Ann. Surg. 1943; 117: 498
- Clinical Use of Amiuo Acids for the Maintenance of Nitrogen Equilibrium.J. A. M. A. 1943; 121: 163
- The Treatment of Peptic Ulcer.J. B. Lippincott Company, Philadelphia1944
- Carcinoma in Situ of the Stomach and Its Bearing on the Histogenesis of Malignant Ulcers.Arch. Path. 1940; 30: 348
- Duration of Cancer of the Stomach.Gastroenterology. 1943; 1: 723
- Lea & Febiger, Philadelphia1941: 511 (See discussion in Portis, Sidney A.) Diseases of the Digestive System.
- Carcinomatous Ulcer.J. A. M. A. 1942; 118: 1
- Gastroduodenal Disorders: An Important Wartime Medical Problem.War Med. 1942; 2: 967
- The Emotional Component of the Ulcer Susceptible Constitution.Ann. Int. Med. 1942; 16: 633
- The Man-Environment Unit and Peptic Ulcer.Arch. Int. Med. 1932; 49: 616
- Evidence on Genesis of Peptic Ulcer in Man.J. A. M. A. 1942; 120: 670
- Emotions and Gastro-duodenal Function.Psychosom. Med. 1942; 4: 5
Received: July 17, 1944
© 1945 Published by Elsevier Inc.