Gastrointestinal complications postthoracotomy and postvagotomy.
Postthoracotomy gastrointestinal complications, although relatively uncommon, can be associated with significant morbidity and mortality. It is necessary to identify patients who are at high risk for gastrointestinal complications during the preoperative evaluation. Appropriate stress ulcer prophylaxis should be provided to high-risk patients, and enteral feeds should be initiated as early in the postoperative course as possible. Postoperative hypotension and massive blood transfusions can be avoided with early reexploration in the case of postoperative hemorrhage. Finally, unexplained abdominal pain must not be ignored; a high index of suspicion should be maintained, with early and liberal use of diagnostic tools such as standard radiography, CT, endoscopy, and angiography. Consultation should be requested from a surgeon experienced in abdominal catastrophes. Early laparotomy with aggressive operative management can be lifesaving therapy but must be not applied in a cavalier fashion, as many of these disorders can and should be managed conservatively.
Kokoska
E R
ER
Theodore Cooper Surgical Research Institute, St. Louis, Missouri, USA.
Naunheim
K S
KS
D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D010437:Peptic Ulcer / Q000150:complications; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D013908:Thoracotomy; D014628:Vagotomy