UPPER GASTROINTESTINAL-BLEEDING FOLLOWING MAJOR SURGICAL-PROCEDURES -PREVALENCE, ETIOLOGY, AND OUTCOME

With continuing improvements in the medical therapy of peptic ulcer di sease, the incidence of primary upper gastrointestinal bleeding (UGIB) has markedly declined. Nonetheless, in a subset of surgical patients, secondary UGIB following a major operation may still be a source of s ubstantial morbidity, To further elucidate this problem, we reviewed 1 03 cases of overt UGIB following all major surgical procedures conduct ed in two hospitals between July 1982 and June 1994. The prevalence of postoperative UGIB during this period was 0.39%, The mean interval be tween initial operation and UGIB was 16 days (range 1-55 days) and the re was a high incidence of associated sepsis (26%). The source of blee ding was defined endoscopically in all cases and included gastritis (6 9.9%), solitary ulcers (17.5%), and other causes (12.6%). Postoperativ e UGIB (nonvariceal) was most commonly seen following portacaval shunt ing operations but mortality rates were highest in patients who develo ped UGIB after cardiovascular operations. We conclude that: (1) postop erative UGIB has become a relatively uncommon but still formidable cli nical problem; (2) erosive gastritis continues to be the major source of UGIB but acute ulcers, varices, and other causes contribute to the total; and (3) postoperative UGIB is most likely to be fatal in cardio vascular patients and those who develop concurrent sepsis and/or multi organ failure. (C) 1996 Academic Press, Inc.