Stress ulceration requiring definitive surgery after severe trauma

Ben L. Zarzaur, Kenneth A. Kudsk, Katrina Carter, F. Elizabeth Pritchard, Timothy C. Fabian, Martin Croce, Gayle Minard

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Despite antiulcer prophylaxis 19 severely injured patients at our institution developed stress ulceration (SU) between 1989 and 1999 requiring surgery for perforation (n = 4) or bleeding (n = 15). A herald bleed (HB) 10.7 ± 1.2 days after admission, 7.2 ± 1.2 days before definitive operative therapy, and requiring 7.1 ± 0.9 units of blood occurred in 93 per cent of patients operated on for bleeding. Bleeding preceded perforation in one patient. Central nervous system damage was part of the injury pattern in 68 per cent of the patients including spinal cord (42%), severe head injury (16%), or both (10%). Forty-two per cent had acalculous cholecystitis found at surgery. Eight patients had vagotomy and antrectomy (VA), and 11 patients had vagotomy and pyloroplasty (VP). VA required more time than VP (255 ± 41 vs 158 ± 13 minutes; P = 0.02). One patient (12.5%) rebled after VA versus two (18%) after VP; one patient in each group required reoperation. There was no difference in mortality, length of stay, or intensive care unit stay. A herald bleed preceded recurrent hemorrhage of SU by one week. Spinal cord or head injury increase the risk of SU. More than 40 per cent of patients with SU had acalculous cholecystitis found at operation. VA provides no benefit on rebleeding or reoperation over VP, so anatomical considerations and not rebleed rates should determine the surgical procedure.

Original languageEnglish (US)
Pages (from-to)875-879
Number of pages5
JournalAmerican Surgeon
Volume67
Issue number9
StatePublished - 2001

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Vagotomy
Wounds and Injuries
Acalculous Cholecystitis
Hemorrhage
Reoperation
Craniocerebral Trauma
Spinal Cord Injuries
Intensive Care Units
Length of Stay
Spinal Cord
Central Nervous System
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Zarzaur, B. L., Kudsk, K. A., Carter, K., Pritchard, F. E., Fabian, T. C., Croce, M., & Minard, G. (2001). Stress ulceration requiring definitive surgery after severe trauma. American Surgeon, 67(9), 875-879.

Stress ulceration requiring definitive surgery after severe trauma. / Zarzaur, Ben L.; Kudsk, Kenneth A.; Carter, Katrina; Pritchard, F. Elizabeth; Fabian, Timothy C.; Croce, Martin; Minard, Gayle.

In: American Surgeon, Vol. 67, No. 9, 2001, p. 875-879.

Research output: Contribution to journalArticle

Zarzaur, BL, Kudsk, KA, Carter, K, Pritchard, FE, Fabian, TC, Croce, M & Minard, G 2001, 'Stress ulceration requiring definitive surgery after severe trauma', American Surgeon, vol. 67, no. 9, pp. 875-879.
Zarzaur BL, Kudsk KA, Carter K, Pritchard FE, Fabian TC, Croce M et al. Stress ulceration requiring definitive surgery after severe trauma. American Surgeon. 2001;67(9):875-879.
Zarzaur, Ben L. ; Kudsk, Kenneth A. ; Carter, Katrina ; Pritchard, F. Elizabeth ; Fabian, Timothy C. ; Croce, Martin ; Minard, Gayle. / Stress ulceration requiring definitive surgery after severe trauma. In: American Surgeon. 2001 ; Vol. 67, No. 9. pp. 875-879.
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