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Chapter 19 - Postoperative gastrointestinal complications

from Section 5 - Gastroenterology

Published online by Cambridge University Press:  05 September 2013

By
Andrew Boxer  and
Michael A. Poles
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Introduction

Gut function is often impacted by surgical interventions, and postoperative gastrointestinal complications are common. Fortunately, most are minor and self-limited, but a number may be severe, and rarely, life threatening. Many of the complications can either be prevented or treated with proper prophylaxis and early recognition. Given the escalating use of bariatric surgery in the treatment of obese patients, this population is faced with unique postoperative issues.

Postoperative gastrointestinal bleeding

Postoperatively, gastrointestinal bleeding is an uncommon but potentially serious complication. Clinically significant bleeding occurs in 0.5–1% of patients in the acute postoperative setting [1,2]. The major causes of acute postoperative bleeding include stress ulceration, bleeding from an intestinal anastamosis, ischemic colitis, and bleeding from preexisting lesions such as gastroduodenal ulcers and diverticular disease. Gastrointestinal hemorrhage temporally remote from surgery occurs less commonly, but may be due to aortoenteric fistulae and recurrent or marginal ulcer disease.

Stress-related mucosal disease

Stress-related mucosal disease (SRMD), or stress-ulceration is the most common cause of postoperative GI bleeding, although its incidence has decreased with increased use of prophylaxis since 1999 [3,4]. Stress ulcers are primarily believed to be due to disturbances in the mucosal microcirculation, with relative local hypoperfusion causing a loss of mucosal integrity, an imbalance between aggressive and protective factors and subsequently development of multiple gastric erosions and ulcerations [5–7]. Suppressing gastric acid secretion is currently the best way to protect against these mucosal events; antisecretory agents have been employed successfully for prophylaxis of SRMD in high-risk patients [8].

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 208 - 214
Publisher: Cambridge University Press
Print publication year: 2013

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