Acute haemorrhage from gastric malignancy.

The presentation, pathology and treatment of 30 patients with acute bleeding from gastric malignancies has been reviewed. Patients usually have a history of symptoms of less than 6 months prior to bleeding. Adenocarcinoma was the commonest type of tumour, and 74 per cent were stage IV lesions. The proportion of lesions in the body of the stomach (57 per cent) was greater than expected, suggesting that these are different populations of gastric tumour. Laparotomy was undertaken in 20 patients, 12 of whom had a resection. Resection was associated with a median survival of 17.0 months. Those with unresectable tumours or who were treated only by supportive measures had a median survival of only 2.5 months (P less than 0.01). Evidence of peritoneal or liver involvement should contraindicate surgical intervention as these patients have a high postoperative mortality rate.