Abstract
As the ability to prolong life in severely traumatized patients increased, the incidence of clinically apparent upper gastrointestinal hemorrhage also increased. By 1970, it was recognized that the most common cause of such bleeding was so-called stress ulceration, consisting of multiple, punctate, superficial erosions, confined initially to the proximal gastric mucosa. “Stress” ulcers develop in association with shock which requires massive transfusion, with certain types of central nervous system injury, with respiratory insufficiency, with acute renal failure, and, most particularly, with sepsis. Active bleeding from “stress” ulcer is usually preceded by a striking increase in the volume and acidity of aspirated gastric content, which is also heavily bile stained. Abnormalities in coagulation are frequently present. The nasogastric tube, per se, does not contribute to “stress” bleeding. Intraoperative endoscopy for diagnosis is of value in selected instances.
Résumé
Lorsque nos thérapeutiques sont devenues capables de prolonger l'existence des traumatisés graves, nous avons vu s'accroître parallèlement la fréquence des hémorragies digestives hautes. On a montré, dès 1970, que la cause la plus fréquente de ces hémorragies est l'ulcère dit de stress, qui consiste en ulcérations superficielles, punctiformes, localisées, au début, à la muqueuse fundique. L'ulcère de stress apparait chez les malades en état de choc qui ont besoin de transfusions massives, dans certaines lésions du système nerveux central, dans l'insuffisance respiratoire, dans l'insuffisance rénale aiguë et surtout chez les malades infectés. L'hémorragie sur ulcère de stress, est, en général, précédée d'une augmentation importante du volume et de l'acidité du contenu gastrique recueilli par aspiration qui est, de plus, fortement teinté de bîle. Il y a fréquemment des troubles de la coagulation. La sonde d'aspiration gastrique n'est pas elle-même responsable de l'hémorragie sur ulcère de stress. Dans certains cas choisis, l'endoscopie peropératoire peut être utile au diagnostic.
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Lucas, C.E. Stress ulceration: The clinical problem. World J. Surg. 5, 139–148 (1981). https://doi.org/10.1007/BF01658275
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DOI: https://doi.org/10.1007/BF01658275