J.Jpn. Surg. Soc.. 80(3): 211-225, 1979

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Original article

STUDIES ON THE POSTOPERATIVE MASSIVE GASTROINTESTINAL HEMORRHAGE

The massive gastrointestinal bleeding is one of the most intractable and serious complication after operation. This is a big problem in surgery, but at present time the etioloy and treatment of this ulcer is a matter of debate and still remains unsettled.
We experienced 41 cases (1.7%) of massive G.I. hemorrhages among 2.457 cases during the past 10 yeras. G.I. hemorrhage after operations of gastroduodenum and esophagus are excluded because these bleeding is closely related to operative method itself. Massive G.I. hemorrhage following serugical treatment were defined as those in which bleeding occured within 4 weeks after operation and required more than 1.000 ml of blood transfusion. Age of the pateitns ranged from 5 to 76. Average was 53.0 There were 25 males (61%) and 16 femals.
Massive G.I. bleeding 4.4. to 1.1. % followed after thoracic, abdominal, vascular and cardiovascular surgery.
41 cases of massive G.I. bleeding were classified into 3 groups according to the macroscopic findings of the stomach and duodenum.
Group I acute lesion of the stomach and duodenum. (28 cases)
Group II activation of the chronic lesions. (5 cases)
Group III others. (8 cases)
Group I were divided into 3 types, namely, Type A diffuse multiple gastric lesions. (13 cases),
Type B: acute ulcer in upper portion of the stomach (8 cases), and Type C: acute duodenal ulcer (7 cases)
Group II were also divided into 2 types that is to say, Type A Gastric ulcer (3 cases) and Type B duodenal ulcer (2 cases).
On the histopathologic findings of the Group I, there were no findings of granulation and regeneration, however there found intensive congestion of mucous and submucous vessls, atrophy of mucosa and round cell infiltration variously. The microscopic findings of the Group II were that of the chronic ulcer with remarkable granulation, regeneration and revascularisation. In these cases there were findings of no mucous atrophy and very slight congestion, however remarkable round cell infiltration.
Our programm of treatment for postoperative massive hemorrhage is 1. Observation by endoscopy 2. Gastric cooling 3. Surgical treatment when the gastric coolin has no effects. Regarding the treatment of acute multiple lesions, since operative results of the gastric cooling or operation were extremely poor, effectiveness of the treatment for the complication such as severe infection, shock, jaundice and renal failure was considenced to be more influential upon the prognosis.
On the other hand, in cases with a localized lesion, early operation was more effective than gastric coolings.
Treatment of the cases bleeding occurs except gastroduodemum is a topic for further discussion.

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