Upper gastrointestinal bleeding associated with biliary diversion

Significant upper gastrointestinal bleeding following operation was noted in 14 of 218 patients undergoing external biliary drainage. None of these patients sustained hepatic injury or needed hepatic resection. Three patients died from causes related to the upper gastrointestinal hemorrhage, and in 12 of the 14 patients the episode of hemorrhage occurred within three days of the biliary tract operation. The majority of the patients were febrile or septic at the time of the biliary operation. Biliary tract infection, when combined with external biliary drainage, may predipose to major upper gastrointestinal hemorrhage.