Abstract
Hemorrhage from gastritis occurring within the first month after direct procedure for esophageal varices was studied. Three of 473 cases (0.6%) bled from endoscopically diagnosed gastritis. All 3 cases underwent the one-stage combined procedure of transthoracic esophageal transection and transdiaphragmatic splenectomy and paraesophagogastric devascularization. However, they did not undergo pyloroplasty, as is our usual procedure with paragastric devascularization. Only 4 cases underwent a one-stage operation without pyloroplasty, and 3 of them (75%) had complicating hemorrhagic gastritis. A possible cause of the hemorrhagic gastritis is a combination of decreased gastric mucosal defense factors with changes in gastric mucosal blood flow due to wide paragastric devascularization and increased gastric mucosal attack factors with disturbance of gastric emptying due to vagotomy. It may be conculuded that these changes remain only a short time after operation, because recurrent bleeding has not occurred in the 3 cases.
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