A healthy 75-year-old man bleeds from a duodenal ulcer. Medical management and endoscopic measures fail to stop the bleeding. What is the next step in management?
In general, surgery for peptic ulcer bleeding is indicated at an earlier stage in an older patient because vessels are atherosclerotic and less likely to stop bleeding spontaneously. In addition, diminished perfusion of the heart, brain, and kidneys is less well tolerated in elderly patients. At surgery, the gastroduodenal artery is oversewn, and a vagotomy and drainage procedure is performed.
Continued transfusion of 8 U of blood
Administration of norepinephrine
Oversewing of the bleeding point
Oversewing of the bleeding point, vagotomy. and pyloroplasty
Stomach & Duodenum