UPPER GASTROINTESTINAL-BLEEDING IN OPERAT ED STOMACH (BILLROTH-I AND II) - MILD COURSE AND PROGNOSIS

Aim: To determine course and prognosis of upper gastrointestinal bleed ing in gastrectomized patients. Materials and methods: We have conduct ed a retrospective study on 34 patients (one female, mean age 38.2 +/- 12.14 years) admitted with upper gastro-intestinal bleeding between N ovember 1989 and August 1991. All patients had been previously gastrec tomized because of benign gastric pathology. Eight had a Billroth I ty pe gastrectomy, and 26 a Billroth II. Results: The causes of gastroint estinal bleeding were recurrent ulcer in 20 patients and alcaline refl ux gastritis in 13 patients, both located at the surgical anastomosis; in one case it was not possible to determine the lesion responsible o f the bleeding. Initial symptoms were maelena in 16 patients (47%), he matemesis in 12 patients (35.2%) and hematemesis and maelena in 6 (17. 6%). Only one patient developed hemodynamic changes (systolic arterial tension < 10 mm Hg and pulse > 100 pm). After admission 3 patients re bled (8.8%) and the mortality reached 8.8%. Although rebleeding and mo rtality rates were higher than the rates for peptic ulcer in non gastr ectomized patients, mortality and rebleeding ocurred in patients with severe diseases (chronic hepatopathy), whose evolution conditioned in 2 of 3 patients the course of the upper gastrointestinal bleeding. Con clusions: The evolution of bleeding was not influenced by the causal l esion or the gastric resective procedure. We conclude that the course and prognosis of upper gastrointestinal bleeding in gastrectomized pat ients is not severe; hemostatic surgical procedures are indicated in o nly a minority of patients.