[Upper digestive hemorrhage in the operated stomach (Billroth I and II): clinical course and prognosis].
OBJECTIVE
To determine course and prognosis of upper gastrointestinal bleeding in gastrectomized patients.


METHODS
We have conducted a retrospective study on 34 patients (one female, mean age 38.2 +/- 12.14 years) admitted with upper gastrointestinal bleeding between November 1989 and August 1991. All patients had been previously gastrectomized because of benign gastric pathology. Eight had a Billroth I type gastrectomy, and 26 a Billroth II.


RESULTS
The causes of gastrointestinal bleeding were recurrent ulcer in 20 patients and alkaline reflux gastritis in 13 patients, both located at the surgical anastomosis; in one case it was not possible to determine the lesion responsible of the bleeding. Initial symptoms were maelena in 16 patients (47%), hematemesis 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 rebled (8.8%) and the mortality reached 8.8%. Although rebleeding and mortality rates were higher than the rates for peptic ulcer in non gastrectomized patients, mortality and rebleeding occurred in patients with severe diseases (chronic hepatopathy), whose evolution conditioned in 2 of 3 patients the course of the upper gastrointestinal bleeding.


CONCLUSIONS
The evolution of bleeding was not influenced by the causal lesion or the gastric resective procedure. We conclude that the course and prognosis of upper gastrointestinal bleeding in gastrectomized patients is not severe; hemostatic surgical procedures are indicated in only a minority of patients.
Erdozain Sosa
J C
JC
Servicio de Aparato Digestivo, Hospital La Paz, Madrid.
Guerrero Vega
E
E
Martín-de-Argila
C
C
González Murillo
M
M
Presa Valle
M
M
Muñoz Núñez
F
F
Lizasoain Urkola
J
J
Suárez de Parga
J
J
Herrera Abian
A
A
Molina Pere
E
E
D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
Hemorragia digestiva alta en el estómago operado (Billroth I y II): curso y pronóstico.