Acute massive hemorrhage from peptic ulceration immediately following unrelated major surgery

Abstract

Surgical intervention immediately following unrelated surgical procedures in the abdomen occurs infrequently. In the case reported herein, after cholecystectomy and the onset of gastric hemorrhage, the general condition of the patient deteriorated despite conservative medical management of sixty hours. During this time 4,000 ml. of whole blood was administered. Emergency surgery was necessary; subtotal gastric resection was performed five days after cholecystectomy. Multiple peptic erosions of the fundus of the stomach were found as the source of acute massive postoperative hemorrhage. The importance of prompt and aggressive treatment of the patient with postoperative hemorrhaging is emphasized. If conservative medical measures fail, early surgical intervention is required to save many desperately ill patients, particularly older patients. Many other postoperative problems were encountered in the present case. An unusual wound complication developed, presumably the result of the almost “simultaneous” use of two contralateral paramedian abdominal incisions. As a consequence of this experience, it is suggested that the surgeon should avoid, whenever possible, making contralateral paramedian abdominal incisions within a short period of time.