Today,I assisted a surgeon for reoperate(3 times)a patient for a massive upper GI bleeding.The original operation was 18 days ago,and the pre op. endoscopy only can all the stomach with coagulated blood.The surgeon opened the anterior wall of the stomach,and "found" a small Dielafoi ulcer(vascular malformation).So, he resected a small surface of the fundus and close the stomach.The patient go well for 4 days,but,before his discharge,rebleeding massivly.So,he was reexplored,and then the surgeon found again the stomach full of blood,and he performed the old"blunt total gastrectomy",with esophago-jejuno anastomosis.The post op was torpid,septic and bleeding.A upper x Ray,showed a small-medium fistula.When the patient fall in Hipovolemic shock for n times,a upper endoscopy shows a "granuloma" bleeding in the lower esophagus or in the anastomosis area.For a persistent and massive bleeding,to day was reexplored,and ,we found all the bowell full of bluts,;we open the anastomosis esophago-jejunal and a big arterial bleeding occurred,with hemodinamics fall.I pack" the area and the surgeon tell me that this patient had had a Anti reflux surgery 15 years ago:Hill Procedure ,very common in my country.(1-3 stitchs ,Arcuate lig./and Cardias,silk 0). Suddenly I remembered other patient,with the same procedure and the same recurrent and letal,upper GI bleeding:ESOPHAGEAL-AORTIC FISTULA,that I knew 10 years ago.
We need open the left chest,crossclamping the aorta,and to put one prolene stitch in the abdominal aorta for stop the bleeding.Now,the patient is a disaster,Bogota bag,MOF,and terminal cervical esophagostoma,etc... So, the reflux surgery have late complications.