An exceptional postoperative gastric tube bleeding after esophageal resection for cancer.
A case of gastric tube bleeding after an Ivor-Lewis esophagectomy with gastroesophageal anastomosis is reported. During the early postoperative course, the patient had a gastric tube stasis that improved progressively. The subsequent onset of a serious and intermittent hematemesis, which was endoscopically deemed to be the result of a hemorrhagic gastritis, required multiple blood transfusions. The evolution to a severe hemodynamic instability obliged us to reoperate on the patient. During surgery, a band-related obstruction of the first jejunal loop with local signs of vascular hypertension was noted. As soon as the obstruction was solved, the gastric bleeding stopped. The authors discuss the clinical aspects and physiopathology of the gastric tube bleeding and, in particular, they evaluate the influence of the intestinal obstruction with vascular involvement on the development of this exceptional and severe complication.
Di Mauro
Davide
D
Department of Surgical Clinics and Therapy, Azienda Ospedaliero-Universitaria, Parma, Italy. ddmauro@hotmail.it
Sarli
Leopoldo
L
Roncoroni
Luigi
L
D000230:Adenocarcinoma / Q000601:surgery; D000714:Anastomosis, Surgical; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005756:Gastritis / Q000209:etiology; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D006940:Hyperemia / Q000209:etiology; D007415:Intestinal Obstruction / Q000150:complications; D007579:Jejunal Diseases / Q000150:complications; D007583:Jejunum / Q000098:blood supply; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012771:Shock, Hemorrhagic / Q000209:etiology; D013270:Stomach / Q000601:surgery*; D000267:Tissue Adhesions / Q000150:complications