Symptomatoloyy

The disease begins with severe large gastric hemorrhages which recur at short intervals. In the midst of health the patient is suddenly overcome with vomiting of very large quantities of blood (half a litre to one litre), which may be also accompanied by mekena. Within a few days after the 17 onset of the disease, sometimes even within a few hours, the patient may be moribund. He resembles a man in whom an artery has been opened and who dies from the hemorrhage. There is almost always, following the hemorrhage, a rise in temperature which is of irregular type and lasts a few days. The general symptoms are not much different from those encountered after any considerable loss of blood, and consist in phenomena of extreme anaemia of the brain, dizziness, lightheadedness, tinnitus aurium, syncope. The disease very often ends fatally as a result of the exsanguination. In some of the cases, however, the hemorrhage after having occurred two or three times does not reappear, and the patient gradually recovers.

Diagnosis

A probable diagnosis of exulceratio simplex can be made if there have been no gastric symptoms whatever previous to the present disease, and there exist extensive hemorrhages from the stomach which recur at short intervals. In exceptional cases there may have also been present gastric symptoms, like gastralgia, nausea, vomiting. Most frequently, however, the hemorrhage appears in the midst of perfect health. The differential diagnosis between ulcer of the stomach and exulceratio simplex is certainly very difficult and can hardly ever be made without a necropsy or an autopsy in vivo. In the ordinary ulcer, however, there are always preceding pains and other gastric symptoms, and the hemorrhages are as a rule not so large. In erosions of the stomach the disease shows a chronic type, and there are no profuse hemorrhages.

Prognosis

The prognosis of exulceratio simplex is extremely grave.

Treatment

The treatment of superficial ulceration of the stomach coincides with that of gastric hemorrhage. The patient should be kept abed, perfectly quiet, with an ice-bag over the gastric region, should not be allowed to take anything by the mouth, and be nourished by the rectum. Subcutaneous injections of normal salt solution should be frequently made. Dieu-lafoy recommends subcutaneous injections of 200-500 gm. at a time of the following solution:

℞ Sodium chloride.......8.0

Caffeine benzoate,.....0.1

Water,.......1,000.0

Oxygen inhalations and injections of ether and camphor must be frequently made when attacks of syncope are imminent. In order to favor the arrest of the hemorrhage by means of coagulation, subcutaneous injections of a two-per-cent gelatin solution in the amount of 100 gm. at a time can be employed with great advantage. I have used this procedure in two cases of very severe gastric hemorrhages, one due to an ordinary ulcer, the other most probably due to a superficial ulceration, with good result. It is self-understood that thorough sterilization of the gelatin solution and perfect asepsis in the manipulation of the injections are required. The injections are best made in the gluteal region.

In cases of a very severe type, Dieulafoy recommends operative intervention. The stomach is opened and the superficial ulceration when found sutured. The indication for surgical intervention exists if the medical treatment proves ineffective, if a copious haematemesis appears at short intervals, and syncope becomes imminent.