The bleeding gastric ulcer - will it bleed again, and if so, why? A case for repeat endoscopy in evaluating stigmata
The original publication is available at http://www.samj.org.za
Nine patients qualified for surgery for a bleeding gastric ulcer - all had a 'visible vessel'. Three of these vessels were thrombosed including 2 in patients who had been in shock. The smallest patent vessel was 0,35 mm in diameter, and 6 of the bleeding vessels were subserosal. The features thought to predispose to further bleeding were vessel size, a lateral hole in the main trunk of the vessel and, possibly, previous recanalization or ingestion of a drug which affected haemostasis. Five of 6 patent arteries had a cap of thrombus over the breach forming a false aneurysm. It is suggested that clinically these should pulsate, enlarge, leak - with persistent fresh thrombus in the ulcer crater on repeat endoscopy - and finally rupture. Where the underlying vessel is thrombosed the stigmata of a non-pulsatile 'visible vessel' or thrombus in the ulcer should disappear on repeat endoscopy. The sizes of the arteries in the normal antrum are tabulated.
- BB - Editors737