Nine Cases of Gastroduodenal Ulcer with Hemorrhagic Shock Requiring Surgery

Abstract

Endoscopic hemostasis is the treatment of first choice for cases of hemorrhagic gastroduodenal ulcers. If the treatment fails, interventional radiology or surgery is selected. The concept of damage control surgery (DCS) is very useful for cases of hemorrhagic gastroduodenal ulcer with unstable hemodynamics. We studied the data of 9 cases of hemorrhagic gastroduodenal ulcers who underwent surgery at our institution between January 2019 and December 2023. All patients were male, with a mean age of 73 years. They were all in a state of hemorrhagic shock, and resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed in 6 cases. One case of out-of-hospital cardiac arrest was operated upon, without endoscopic treatment. Suture hemostasis was performed in 8 cases and gastrectomy in 1 case, out of which, in 2 cases, reoperation was planned. The intraoperative blood loss differed between patients with and without REBOA. We could not save two patients who suffered from a cardiac arrest during treatment. In the critical situation of a bleeding gastroduodenal ulcer, REBOA and DCS can be utilized to ensure rapid and accurate hemostasis.