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A Case of Postoperative Intestinal Hemorrhage: Demonstration of Bleeding Site by Selective Angiography K. Ohsato 1 , S. Nagamitsu 1 , F. Zeze 1 , K. Takao 1 , M. Takahashi 2 , M. Tanaka 2 11st Dept. of Surgery, Faculty of Medicine, Kyushu University pp.621-625
Published Date 1971/5/25
DOI https://doi.org/10.11477/mf.1403111634
  • Abstract
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 There are two types of causes of postoperative hemorrahge in the digestive tract. The one is generalized hemorrhagic diathesis and the other is injury of vessel, such as bleeding from the anastomosed site and postoperative peptic ulcer.

 A case of massive bleeding has recently encountered in a patient occurring 21 days after drainageoperation of the bile duct for cancer of the porta hepatis followed by circulatory collapse. As the patient had been suffering from intense jaundice of long duration, hemorragic diathesis due to hepatic failure had to be examined. Furthermore, local causes of bleeding had to be considered as well such as cancer lesion of the bile duct, two sites of anastomoses between the intrahepatic bile duct and the jejunum and the place of Roux-en-Y side-to-end jejunal anastomosis.

 In the emergency case such as the pateint in this case, an imprudent exploratory laparotomy under the insufficient cliniical data should be avoided, because both the cause and site of bleeding remain unaccounted for. Therefore, while trying to improve general condition of the patient by blood transfusion, intravenous fluid infusion and oxygen inhalation, the hemostatic mechanism of the patient was examined to be negative. Then the selective angiography was performed. Bleeding point was confirmed from a blanch of jejunal artery at the site of Roux-en-Y anastomosis.

 Laparotomy was done at once, directly aiming at the site of the anastomosis. The cause of bleeding was thus easily ascertained.

 Retrospective study of the findings seen at the time of surgical intervention suggests that had exploratory laparotomy been performed without confirming the bleeding point, the result would have been either that the site of bleeding would be impossible to find out, or that, even if found, the operation would have faced unforeseen difficulties.

 The authors are now of opinion that the importance of selective angiography in the diagnosis of hemorrhage from the digestive tract should be fully realized.


Copyright © 1971, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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