Massive upper GI bleeding - Forum

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Massive upper GI bleeding - Ärzteforum

Post#1 »

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.

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Re: Massive upper GI bleeding - Ärzteforum

Post#2 »

If you could talk to the patient you would probably learn that the anti-reflux procedure was not indicated. But your patient won't talk again. Aorto-esophageal fistula is well recognized. Has it been reported after Hill's procedure? I suppose the multi-filament non -absorbable suture functioned as a nidus of chronic infection-inflammation- slowly slowly, mm' after mm' ,producing the fistula. Today, while you removed the silk from the aorta- I removed an Ethibond suture- placed a year ago to close an umbilical port after LC . It presented with a small umbilical abscess. I do not understand why people are so stubborn- persisting in usage of multi-filament non-absorbable rubbish, when there are so many better materials available.

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