Stress Ulcers in Critically Ill Patients: A Series of Seven Cases

Year 1975, Volume: 28 Issue: 3-4 , 603 - 612 , 30.09.1975

İsmail Kayabalı

https://izlik.org/JA48ZK25FK

Abstract

1966–1975 yılları arasında Ankara Üniversitesi Genel Cerrahi Kliniği’nde tedavi edilen yedi hastanın stres ülserleri retrospektif olarak incelendi. Yaşları 24–52 arasında değişen (ortalama 39) altı erkek ve bir kadın, karın travması, önceki cerrahi girişimler, sepsis veya steroid tedavisi gibi büyük kritik stres etkenlerini takiben akut kanamalı gastroduodenal ülserler geliştirdi.

Hepsi üst gastrointestinal kanamaya bağlı hipovolemik durumla kliniğe başvurdu; yalnızca iki olguda (bir duodenum ülseri, bir hemorajik gastrit) endoskopi veya anjiyografi ile lezyon lokalize edilebildi. Transfüzyon gereksinimi olguların bazısında 30 üniteye kadar çıktı.

Dört hasta medikal (nazogastrik dekompresyon, asit supresyon, hacim resüsitasyonu, farmakoterapi) ve üç hasta cerrahi (vagotomi + arter ligasyonu veya drenaj) yöntemlerle tedavi edildi. Buna rağmen yedi hastanın altısı kaybedildi ve toplam mortalite %85 olarak gerçekleşti.

Yazarlar, stres ülserlerinin patogenezinde mukozal iskemi, asit-pepsin hipersekresyonu, enfeksiyon ve nörojenik mekanizmaların rol oynadığını; medikal tedavi başarısızlığında gecikmeden subtotal gastrektomi ile vagotominin en etkili müdahale olduğunu vurgulamaktadır.

Keywords

Stres ülserleri , Akut gastroduodenal kanama , Travma , Büyük cerrahi girişim , Mortalite , Cerrahi müdahale , Gastroduodenal ülserler

Stres Ülserleri: Yedi Olguluk Seri

https://izlik.org/JA48ZK25FK

Abstract

This retrospective series reviews seven patients treated for stress-related gastrointestinal ulcers at Ankara University Surgical Clinic between 1966 and 1975. Six men and one woman, aged 24 to 52 (mean 39), developed acute bleeding ulcers after major stressors including blunt abdominal trauma, prior abdominal operations, sepsis, or steroid therapy.

All presented with ongoing upper GI hemorrhage unresponsive to initial measures; endoscopic or radiologic localization was possible in only two cases (one duodenal ulcer, one hemorrhagic gastritis). Transfusion requirements were extreme, reaching up to 30 units of blood in the most severe case.

Four patients underwent aggressive medical management—nasogastric decompression, acid suppression, volume resuscitation, and pharmacologic therapies—while three required surgical intervention (vagotomy with arterial ligation or drainage). Despite these efforts, six of seven patients died, yielding an overall mortality of 85%.

The authors discuss pathophysiologic mechanisms—mucosal ischemia, acid-pepsin hypersecretion, infection, and neurogenic factors—and highlight the critical need for early recognition. They conclude that if medical therapy fails, prompt definitive surgery (subtotal gastrectomy with vagotomy) offers the best chance to control hemorrhage and reduce recurrence.

Keywords

Stress ulcers , Acute gastroduodenal bleeding , Trauma , Major surgery , Sepsis , Steroid therapy , Gastroduodenal ulcers , Surgical intervention , Mortality , Medical management

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