2003 Volume 23 Issue 5 Pages 757-763
Between January 1996 and December 2002, a total of 1974 patients underwent surgery for different gastrointestinal malignancies at our institution. Twenty-eight patients (1.4%) suffered significant postoperative (post op) hemorrhages. Post-op hemorrhage was more common after surgeries for biliary and gastric cancers (5.5% and 2.1% respectively). Patients with post-op hemorrhage could easily be divided into two groups, depending on the underlying etiology. The early group experienced hemorrhages during the first three days after surgery; the causes of these hemorrhages were partly attributable to the surgical technique. In the late group, however, the hemorrhages occured mainly after the first post op week (day 14. 3±9.8 days) and were mostly related to an underlying intraabdominal sepsis secondary to anastomotic insufficiency and fistula formation. The overall mortality rate in the late group was significantly higher (57.1%) than that in the early group. Most of the late group patients presented with sentinel bleeding before severe hemorrhage. The mortality rate was decreased if an aggressive approach was adopted at the first sign of bleeding (83.3% vs. 16.7%). These results suggest that an aggressive approach should be immediately adopted if sentinel bleeding occurs.
