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Severe Hemorrhage Following Gastrectomy: A Survey of the Literature Relating to Its Frequency, Mortality, Prevention, and Treatment

Severe Hemorrhage Following Gastrectomy: A Survey of the Literature Relating to Its Frequency,... Abstract Serious upper gastrointestinal hemorrhage has occurred as a postoperative complication in 2 of the last 100 consecutive subtotal gastrectomies performed at the Syracuse Veterans Administration Hospital. These cases, which are reported at the close of this article, aroused our interest in this complication. A survey of the literature revealed that there is little information about bleeding as a postgastrectomy hazard in the American surgical literature. This study is designed to determine the actual incidence of this complication and the mortality associated with it and to discuss its etiology, prevention, and treatment. Incidence In 1946, Bruusgaard1 discussed gastrointestinal hemorrhage and reported 11 postoperative hemorrhages in 578 gastric resections, an incidence of 2%. By utilizing all available series which report operative complications following gastric resection,1-38 we have obtained the occurrence rate of serious postoperative hemorrhage. Of 10,919 gastrectomies, 111 involved serious postoperative hemorrhage—an incidence of 1%. Serious hemorrhage occurring more References 1. References 1, 17. 19, 21, 31-33, 35, 36, 38, 53, 54 and Case 2. 2. Bruusgaard, C.: Operative Treatment of Gastric and Duodenal Ulcer: Clinical and Roentgenologic Study , Acta chir. scandinav. ( (Supp. 117) ) 94:66, 1946. 3. Horsley, J. S.: Partial Gastrectomy , J. A. M. A. 89:1652, 1927.Crossref 4. Lake, N. C.: Partial Gastrectomy: Review of 320 Cases , Brit. M. J. 2:49, 1937.Crossref 5. St. John, F. B.; Harvey, H. D.; Giese, J. A., and Goodman, E. N.: Study of Results of Surgical Treatment of Peptic Ulcer , Ann. Surg. 109:193, 1939.Crossref 6. von Haberer, cited by Bruusgaard 1 and Grevillius.17 7. McClure, R. D., and Fallas, L. S.: Partial Gastrectomy for Peptic Ulcer: Review of 74 Operations , Surgery 8:575, 1940. 8. Allen, A. W., and Welch, C. E.: Gastric Resection for Duodenal Ulcer: Follow-Up Studies , Ann. Surg. 115:530, 1942.Crossref 9. Colp, R.; Klingenstein, P.; Mage, S., and Druckerman, L. J.: Subtotal Gastrectomy for Duodenal Ulcer , Ann. Surg. 120:170, 1944.Crossref 10. McKittrick, L. D.; Moore, F. D., and Warren, R.: Complications and Mortality in Subtotal Gastrectomy for Duodenal Ulcer: Report on 2-Stage Procedure , Ann. Surg. 120:531, 1944.Crossref 11. Allen, A. W., and Welch, C. E.: Subtotal Gastrectomy for Duodenal Ulcer , Ann. Surg. 124:688, 1946.Crossref 12. Bartels, R. N., and Dulin, J. W.: Gastric Resection for Peptic Ulcer: Study of 221 Consecutive Cases , Surgery 21:496, 1947. 13. Ranson, H. K.: Subtotal Gastrectomy for Gastric Ulcer: Study of End Results , Ann. Surg. 126:633, 1947.Crossref 14. St. John, F. B.; Harvey, H. D.; Ferrer, J. M., Jr., and Sengstaken, R. W.: Results Following Subtotal Gastrectomy for Duodenal and Gastric Ulcer , Ann. Surg. 128:3, 1948.Crossref 15. Skinner, H. L., and Duncan, R. D.: Gastric Resection for Duodenal Ulcer: Surgical Treatment and Follow-Up Study , Am. J. Surg. 75:721, 1948.Crossref 16. Garlock, J. H., and Lyons, A. S.: The Surgical Therapy of Duodenal Ulcer , Surgery 25:352, 1949. 17. Lyons, C. K., and Grimson, K. S.: Complications Following Subtotal Gastric Resections Performed Since June 1944, for Peptic Ulcer in 132 Patients: Comparison with Complications Following Vagotomy in 138 Patients , Surgery 28:350, 1950. 18. Grevillius, A.: On Complications After Ulcer Resections , Acta. chir. scandinav. 100:311, 1950. 19. Singmaster, L., and Engel, G. C.: Evaluation of Subtotal Gastrectomy for Gastric and Duodenal Lesions Postoperative Survey of 100 Cases , Gastroenterology 17:1, 1951. 20. Ross, F. P., and Warren, R.: Safeguards in Gastric Resection for Duodenal Ulcer , New England J. Med. 245:475, 1951.Crossref 21. Nicolaysen, K., and Fretheim, B.: Partial Gastrectomy for Ulcer and Postoperative Complication , Surgery 30:597, 1951. 22. Bancroft, F. W.: Surgical Problems of Duodenal Ulcer , J. A. M. A. 147:364, 1951.Crossref 23. Levy, A. H.: Partial Gastrectomy for Peptic Ulcer , Am. J. Surg. 81:198, 1951.Crossref 24. Glenn, F., and Harrison, C. S.: Gastric Resection in Treatment of Peptic Ulcer , A. M. A. Arch. Surg. 62:151, 1951.Crossref 25. Lowdon, A. G. R.: Treatment of Acute Perforated Peptic Ulcer by Primary Partial Gastrectomy , Lancet 1:1270, 1952.Crossref 26. Eastman, W. H., and Cole, W. H.: Precautions and Results in Gastrectomy , Arch. Surg. 59:768, 1949.Crossref 27. Palumbo, L. T.; Paul, R. E., and Westley, G. T.: Evaluation of Results for Treatment for Duodenal Ulcer , Am. J. Surg. 84:172, 1952.Crossref 28. Moore, H. G., Jr., and Harkins, H. N.: Critical Evaluation of Billroth I Gastric Resection , Surgery 32:408, 1952. 29. Cannon, J. P.: Experiences with Gastric Resection for Peptic Ulcer , U. S. Armed Forces M. J. 3:1075, 1952. 30. Potter, W. H.; Anderson, M. N., and Stewart, J. D.: Symposium on Geriatric Surgery: Gastric Surgery in Aged; Study of 203 Selected Patients , Geriatrics 7:173, 1952. 31. Babson, W. W.: Gastrectomy in a Community Hospital , New England J. Med. 249:1101, 1953.Crossref 32. Emmett, J. M., and Owen, E. T.: Gastrectomy as a Treatment for Perforated Peptic Ulcers , Ann. Surg. 138:320, 1953.Crossref 33. Wallensten, S.; Gothman, L., and Falun, S.: An Evaluation of the Billroth I Operation for Peptic Ulcer , Surgery 33:1, 1953. 34. Olander, G. A.: Surgical Management of Massive Gastrointestinal Hemorrhage: A Report of 39 Cases , Am. Surgeon 19:1123, 1953. 35. Christmann, F. E.: Patalogía inmediata del estomago operado , Día méd. 25:1306, 1953. 36. Dodson, H. C., Jr.: Partial Gastrectomy for Peptic Ulcer , Am. Surgeon , 19:47, 1953. 37. Kline, P. S.: The Complicated Peptic Ulcer , South. M. J. 45:718, 1952.Crossref 38. Turner, J. W., and Turner, A. B.: Gastrectomies for Benign Peptic Ulcer , J. M. A. Georgia 41:287, 1952. 39. Rothenberg, R. E.: Severe Hemorrhage After Subtotal Gastrectomy , Am. J. Surg. 87:641, 1954.Crossref 40. Still, R. J.: Mortality and Later Results of Subtotal Gastrectomy , Lancet 2:1030, 1936.Crossref 41. Steinberg, M. E.: Surgical Treatment of Gastroduodenal Ulcerations: Technique of Gastric Resection , Surg. Gynec. & Obst. 71:317, 1940. 42. Walters, W.; Lewis, E. B., and Leman, R. G.: Primary Partial Gastrectomy (Polya Type) for Duodenal Ulcer: Study of Results in 212 Cases , Surg. Gynec. & Obst. 71:240, 1940. 43. Miller, G. G.: Report on 230 Cases of Subtotal Gastric Resection for Peptic Ulcer , Surgery 12:383, 1942. 44. Reinhoff, W. F.: An Analysis of the Results of the Surgical Treatment of 260 Consecutive Cases of Chronic Peptic Ulcer of the Duodenum , Ann. Surg. 121:583, 1945.Crossref 45. Well, C., and Brewer, A. C.: Surgery of Duodenal Ulcer , Brit. J. Surg. 35:364, 1948.Crossref 46. Gaviser, D.: Clinical Investigation and Evaluation of 416 Cases Consecutively Operated upon for Peptic Ulcer , Surgery 24:873, 1948. 47. Gray, H. K., and Williams, R. R.: Results of Classic Operations for Duodenal Ulcer , J. A. M. A. 141:509, 1949.Crossref 48. Nuboer, J. F.: Primary Partial Gastrectomy for Perforated Ulcer , Lancet 2:952, 1951.Crossref 49. Rauch, R. F.: Evaluation of Gastric Resection for Peptic Ulcer: Review of 893 Cases , Surgery 32:638, 1952. 50. Bell, L. G.; Sherer, B. D., and Keenoy, J. J.: Experiences with Subtotal Gastrectomy , Ann. Surg. 137:516, 1953.Crossref 51. Report of the Committee on Surgical Procedures of the National Committee on Peptic Ulcer of the American Gastroenterological Association , Gastroenterology 22:297, 1952, p. 441. 52. Jungbluth, J.: Über Nachblutung in Gefolge von Magenoperationen, deren Ursache und Verhutung Zentralbl. Chir. 78:49, 1953. 53. Maingot, R.: Abdominal Operations , Ed. 3, New York, Appleton-Century-Crofts, Inc., 1955, pp. 446-447 and p. 480. 54. Ficarra, B. J.: Postgastrectomy Gastritis , Rev. Gastroenterol. 20:917, 1953. 55. Maxeiner, S. R.: End Results and Complications of the Surgical Management of Peptic Ulcer , Minnesota Med. 34:793, 1951. 56. Cantor, M. O.; Kennedy, C. S., and Reynolds, R. P.: Gelfoam and Thrombin in Treatment of Massive Upper Gastrointestinal Hemorrhage , Am. J. Surg. 82:230, 1951.Crossref 57. Reymond, J. C.: Hemorragie grave de la tranche de section aprés gastrectomie: Traitement par aspration intragastrique continue , Arch. mal. app. digest. 42:399, 1953. 58. Zumtobel, M.: Beitrag zur Vermeidung von Nachblutungen nach Magenoperationen , Zentralbl. Chir. 65:538, 1938. 59. Florcken, H.: Zur Vermeidung von Nachblutungen nach Magenoperationen , Zentralbl. Chir. 60:2013, 1933. 60. Kung, H.: Zur Vermeidung von Nachblutungen en nach Magenoperationen , Zentralbl. Chir. 62:1158, 1935. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

Severe Hemorrhage Following Gastrectomy: A Survey of the Literature Relating to Its Frequency, Mortality, Prevention, and Treatment

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References (66)

Publisher
American Medical Association
Copyright
Copyright © 1957 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1957.01280090043008
Publisher site
See Article on Publisher Site

Abstract

Abstract Serious upper gastrointestinal hemorrhage has occurred as a postoperative complication in 2 of the last 100 consecutive subtotal gastrectomies performed at the Syracuse Veterans Administration Hospital. These cases, which are reported at the close of this article, aroused our interest in this complication. A survey of the literature revealed that there is little information about bleeding as a postgastrectomy hazard in the American surgical literature. This study is designed to determine the actual incidence of this complication and the mortality associated with it and to discuss its etiology, prevention, and treatment. Incidence In 1946, Bruusgaard1 discussed gastrointestinal hemorrhage and reported 11 postoperative hemorrhages in 578 gastric resections, an incidence of 2%. By utilizing all available series which report operative complications following gastric resection,1-38 we have obtained the occurrence rate of serious postoperative hemorrhage. Of 10,919 gastrectomies, 111 involved serious postoperative hemorrhage—an incidence of 1%. Serious hemorrhage occurring more References 1. References 1, 17. 19, 21, 31-33, 35, 36, 38, 53, 54 and Case 2. 2. Bruusgaard, C.: Operative Treatment of Gastric and Duodenal Ulcer: Clinical and Roentgenologic Study , Acta chir. scandinav. ( (Supp. 117) ) 94:66, 1946. 3. Horsley, J. S.: Partial Gastrectomy , J. A. M. A. 89:1652, 1927.Crossref 4. Lake, N. C.: Partial Gastrectomy: Review of 320 Cases , Brit. M. J. 2:49, 1937.Crossref 5. St. John, F. B.; Harvey, H. D.; Giese, J. A., and Goodman, E. N.: Study of Results of Surgical Treatment of Peptic Ulcer , Ann. Surg. 109:193, 1939.Crossref 6. von Haberer, cited by Bruusgaard 1 and Grevillius.17 7. McClure, R. D., and Fallas, L. S.: Partial Gastrectomy for Peptic Ulcer: Review of 74 Operations , Surgery 8:575, 1940. 8. Allen, A. W., and Welch, C. E.: Gastric Resection for Duodenal Ulcer: Follow-Up Studies , Ann. Surg. 115:530, 1942.Crossref 9. Colp, R.; Klingenstein, P.; Mage, S., and Druckerman, L. J.: Subtotal Gastrectomy for Duodenal Ulcer , Ann. Surg. 120:170, 1944.Crossref 10. McKittrick, L. D.; Moore, F. D., and Warren, R.: Complications and Mortality in Subtotal Gastrectomy for Duodenal Ulcer: Report on 2-Stage Procedure , Ann. Surg. 120:531, 1944.Crossref 11. Allen, A. W., and Welch, C. E.: Subtotal Gastrectomy for Duodenal Ulcer , Ann. Surg. 124:688, 1946.Crossref 12. Bartels, R. N., and Dulin, J. W.: Gastric Resection for Peptic Ulcer: Study of 221 Consecutive Cases , Surgery 21:496, 1947. 13. Ranson, H. K.: Subtotal Gastrectomy for Gastric Ulcer: Study of End Results , Ann. Surg. 126:633, 1947.Crossref 14. St. John, F. B.; Harvey, H. D.; Ferrer, J. M., Jr., and Sengstaken, R. W.: Results Following Subtotal Gastrectomy for Duodenal and Gastric Ulcer , Ann. Surg. 128:3, 1948.Crossref 15. Skinner, H. L., and Duncan, R. D.: Gastric Resection for Duodenal Ulcer: Surgical Treatment and Follow-Up Study , Am. J. Surg. 75:721, 1948.Crossref 16. Garlock, J. H., and Lyons, A. S.: The Surgical Therapy of Duodenal Ulcer , Surgery 25:352, 1949. 17. Lyons, C. K., and Grimson, K. S.: Complications Following Subtotal Gastric Resections Performed Since June 1944, for Peptic Ulcer in 132 Patients: Comparison with Complications Following Vagotomy in 138 Patients , Surgery 28:350, 1950. 18. Grevillius, A.: On Complications After Ulcer Resections , Acta. chir. scandinav. 100:311, 1950. 19. Singmaster, L., and Engel, G. C.: Evaluation of Subtotal Gastrectomy for Gastric and Duodenal Lesions Postoperative Survey of 100 Cases , Gastroenterology 17:1, 1951. 20. Ross, F. P., and Warren, R.: Safeguards in Gastric Resection for Duodenal Ulcer , New England J. Med. 245:475, 1951.Crossref 21. Nicolaysen, K., and Fretheim, B.: Partial Gastrectomy for Ulcer and Postoperative Complication , Surgery 30:597, 1951. 22. Bancroft, F. W.: Surgical Problems of Duodenal Ulcer , J. A. M. A. 147:364, 1951.Crossref 23. Levy, A. H.: Partial Gastrectomy for Peptic Ulcer , Am. J. Surg. 81:198, 1951.Crossref 24. Glenn, F., and Harrison, C. S.: Gastric Resection in Treatment of Peptic Ulcer , A. M. A. Arch. Surg. 62:151, 1951.Crossref 25. Lowdon, A. G. R.: Treatment of Acute Perforated Peptic Ulcer by Primary Partial Gastrectomy , Lancet 1:1270, 1952.Crossref 26. Eastman, W. H., and Cole, W. H.: Precautions and Results in Gastrectomy , Arch. Surg. 59:768, 1949.Crossref 27. Palumbo, L. T.; Paul, R. E., and Westley, G. T.: Evaluation of Results for Treatment for Duodenal Ulcer , Am. J. Surg. 84:172, 1952.Crossref 28. Moore, H. G., Jr., and Harkins, H. N.: Critical Evaluation of Billroth I Gastric Resection , Surgery 32:408, 1952. 29. Cannon, J. P.: Experiences with Gastric Resection for Peptic Ulcer , U. S. Armed Forces M. J. 3:1075, 1952. 30. Potter, W. H.; Anderson, M. N., and Stewart, J. D.: Symposium on Geriatric Surgery: Gastric Surgery in Aged; Study of 203 Selected Patients , Geriatrics 7:173, 1952. 31. Babson, W. W.: Gastrectomy in a Community Hospital , New England J. Med. 249:1101, 1953.Crossref 32. Emmett, J. M., and Owen, E. T.: Gastrectomy as a Treatment for Perforated Peptic Ulcers , Ann. Surg. 138:320, 1953.Crossref 33. Wallensten, S.; Gothman, L., and Falun, S.: An Evaluation of the Billroth I Operation for Peptic Ulcer , Surgery 33:1, 1953. 34. Olander, G. A.: Surgical Management of Massive Gastrointestinal Hemorrhage: A Report of 39 Cases , Am. Surgeon 19:1123, 1953. 35. Christmann, F. E.: Patalogía inmediata del estomago operado , Día méd. 25:1306, 1953. 36. Dodson, H. C., Jr.: Partial Gastrectomy for Peptic Ulcer , Am. Surgeon , 19:47, 1953. 37. Kline, P. S.: The Complicated Peptic Ulcer , South. M. J. 45:718, 1952.Crossref 38. Turner, J. W., and Turner, A. B.: Gastrectomies for Benign Peptic Ulcer , J. M. A. Georgia 41:287, 1952. 39. Rothenberg, R. E.: Severe Hemorrhage After Subtotal Gastrectomy , Am. J. Surg. 87:641, 1954.Crossref 40. Still, R. J.: Mortality and Later Results of Subtotal Gastrectomy , Lancet 2:1030, 1936.Crossref 41. Steinberg, M. E.: Surgical Treatment of Gastroduodenal Ulcerations: Technique of Gastric Resection , Surg. Gynec. & Obst. 71:317, 1940. 42. Walters, W.; Lewis, E. B., and Leman, R. G.: Primary Partial Gastrectomy (Polya Type) for Duodenal Ulcer: Study of Results in 212 Cases , Surg. Gynec. & Obst. 71:240, 1940. 43. Miller, G. G.: Report on 230 Cases of Subtotal Gastric Resection for Peptic Ulcer , Surgery 12:383, 1942. 44. Reinhoff, W. F.: An Analysis of the Results of the Surgical Treatment of 260 Consecutive Cases of Chronic Peptic Ulcer of the Duodenum , Ann. Surg. 121:583, 1945.Crossref 45. Well, C., and Brewer, A. C.: Surgery of Duodenal Ulcer , Brit. J. Surg. 35:364, 1948.Crossref 46. Gaviser, D.: Clinical Investigation and Evaluation of 416 Cases Consecutively Operated upon for Peptic Ulcer , Surgery 24:873, 1948. 47. Gray, H. K., and Williams, R. R.: Results of Classic Operations for Duodenal Ulcer , J. A. M. A. 141:509, 1949.Crossref 48. Nuboer, J. F.: Primary Partial Gastrectomy for Perforated Ulcer , Lancet 2:952, 1951.Crossref 49. Rauch, R. F.: Evaluation of Gastric Resection for Peptic Ulcer: Review of 893 Cases , Surgery 32:638, 1952. 50. Bell, L. G.; Sherer, B. D., and Keenoy, J. J.: Experiences with Subtotal Gastrectomy , Ann. Surg. 137:516, 1953.Crossref 51. Report of the Committee on Surgical Procedures of the National Committee on Peptic Ulcer of the American Gastroenterological Association , Gastroenterology 22:297, 1952, p. 441. 52. Jungbluth, J.: Über Nachblutung in Gefolge von Magenoperationen, deren Ursache und Verhutung Zentralbl. Chir. 78:49, 1953. 53. Maingot, R.: Abdominal Operations , Ed. 3, New York, Appleton-Century-Crofts, Inc., 1955, pp. 446-447 and p. 480. 54. Ficarra, B. J.: Postgastrectomy Gastritis , Rev. Gastroenterol. 20:917, 1953. 55. Maxeiner, S. R.: End Results and Complications of the Surgical Management of Peptic Ulcer , Minnesota Med. 34:793, 1951. 56. Cantor, M. O.; Kennedy, C. S., and Reynolds, R. P.: Gelfoam and Thrombin in Treatment of Massive Upper Gastrointestinal Hemorrhage , Am. J. Surg. 82:230, 1951.Crossref 57. Reymond, J. C.: Hemorragie grave de la tranche de section aprés gastrectomie: Traitement par aspration intragastrique continue , Arch. mal. app. digest. 42:399, 1953. 58. Zumtobel, M.: Beitrag zur Vermeidung von Nachblutungen nach Magenoperationen , Zentralbl. Chir. 65:538, 1938. 59. Florcken, H.: Zur Vermeidung von Nachblutungen nach Magenoperationen , Zentralbl. Chir. 60:2013, 1933. 60. Kung, H.: Zur Vermeidung von Nachblutungen en nach Magenoperationen , Zentralbl. Chir. 62:1158, 1935.

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A.M.A. Archives SurgeryAmerican Medical Association

Published: Mar 1, 1957

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