Emergency Surgery Performed in our Department for Patients withGastrointestinal Bleeding in whom Medical Hemostasis was Unsuccessful

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  • 当科における内科的止血困難な消化管出血に対する緊急手術施行例の検討─出血源の特定に苦慮した症例を中心に─

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Abstract

Between 2002 and 2010, 9 patients underwent emergency surgery in our department for gastrointestinal (GI) bleeding. The patients were divided into 2 groups on the basis of the source of bleeding: the upper GI bleeding (4 patients) and lower GI bleeding (5 patients) groups. The following factors were retrospectively investigated and compared for the 2 groups: patient characteristics, preoperative severity, operative management, and treatment outcome. This analysis showed that patient characteristics and preoperative severity were nearly similar for both groups. The duration between the onset of bleeding and surgery for the lower GI bleeding group was significantly longer than that for the upper GI bleeding group; the intraoperative bleeding count was significantly higher for the upper GI bleeding group. For all the patients from the upper GI bleeding group, the source of bleeding was definitively identified by preoperative endoscopy. However, for 2 patients from the lower GI bleeding group, emergency surgery was performed without accurate preoperative identification of the bleeding point. All the patients were alive at discharge. Our results suggest that it is important to immediately identify the source of bleeding by using various diagnostic modalities in the case of lower GI bleeding and to make sufficient preparations for intraoperative blood transfusion in the case of upper GI bleeding.

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