The clinical study was based on 32 cases of acute stress ulcer during 10 years from Jenuary 1973 to December 1982 at the department of general surgery, Seoul Red Cross Hospital.
The results obtained were as follows.
1) The ratio of male to femaie was 4.3:1.
2) The most prevalent age group was between 4th decade and 6th decade(63%).
3) The prethsposing stress factors antedating ulceration were variable, among which postoperative state was the most common one(25%). In 2 cases, no apparent factors were identified.
4) The mean interval from onset of the predisposing factors to the onset of bleeding or parforation was 15 days, except for 2 cases with no apparent predisposing stress factors.
5) Among 28 bleeding cases, diagnosis was based on gross findings by surgeon and report of the pathologist in 14 cases. Endoacopy was useful in 7 cases and no special studies were undertaken in other 7 cases.
6) Among 21 bleeding cases identified by surgeon´s eye or endoscope, 20 cases revealed gastric ulcers and simultaneous gastric and duodenal ulcers were discovered in 1 case. Number of stress ulcers showed multiplicity in 19 cases. 3 patients of acute perforative peptic ulcer had gastric ulcers and 1 patient had duodenal one. Number of perforated opening was single in all cases.
7) The mean interval from onset of bleeding to the time of surgical intervention was 18 hours.
8) Near total gastrectomy was most common type of operation in bleeding cases(5 cases) and total gastrectomy, the next common one(4 cases).
The death rate follwing operation was 20% in the former and 75% in the latter.
Primary closure was the procedure of choice in all 4 perforaing cases with death rate of 25%.
9) Nonoperative treatment and operative treatment for bleeding stress ulcers gained survival rate of 36% and 64%, respectively.
10) Causes of deaths of patients undergoing operation included respiratory failure(2 cases), renal failure(1 case), liver failure(l case) and heart failure(l case) with no recurrent bleeding.
Failure of bleeding control was the most common cause of death of patients undergoing nonoperative treatment(7 cases) and respiratory failure and sepsis were attributable to 2 deaths.
One death in 4 surgically corrected perforating cases was due to sepsis preceded by severe panperitonitis.
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