Bleeding from the upper gastrointestinal tract after Mason's vertical banded gastroplasty

Gastric bleeding is a rare complication after a vertical banded gastroplasty (VBG). Only a few cases of gastric bleeding after a VBG have been reported, and there is discussion about its etiology. We present two cases of gastric bleeding after a VBG, and discuss the etiology, diagnostic approach and management.

During the period 1989-98, we treated two cases of gastric bleeding out of 328 morbidly obese patients that underwent a VBG. The first patient was a 36-year-old woman with body mass index (BMI) 61.5. Gastric bleeding occurred on the 7th postoperative day, due possibly to the increased dose of Low Weight Molecular Heparin (LWMH) which was administrated as prophylactic anticoagulation. The second case concerns a 27-year-old man with 54.0 BMI. Gastric bleeding occurred on the 16th postoperative day and was attributed to a stress ulcer.

Both patients were treated conservatively successfully. In the first patient, bleeding was stopped when LWMH was discontinued. In the second patient, bleeding was stopped by gastroscopic epinephrine injection in the bleeding spot.

From our cases and review of the literature, gastric bleeding after a VBG is rare, may be treated easily with conservative measures. Tension of the mesh that surrounds the canal between the two compartments, gastric mucosal irritation from the nasogastric tube and postoperative stress ulcer formation are the most frequent causes of this complication.