This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Stomach & Duodenum, Subject name: Surgery
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? 
Select and explain. 
A. Continued transfusion of 8 U of blood, B. Administration of norepinephrine, C. Oversewing of the bleeding point, D. Oversewing of the bleeding point, vagotomy. and pyloroplasty
D: Oversewing of the bleeding point, vagotomy. and pyloroplasty
Answer: D: Oversewing of the bleeding point, vagotomy. and pyloroplasty 
Explanation: 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.