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Updated: Jul 14, 2026
Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
[Upper digestive bleedings after cardiac surgery]
M Ait Houssa1, C Selkane, Y Moutaki Allah
1Service de chirurgie cardiovasculaire Hay-Riad, hôpital militaire d'instruction Mohammed-V, 10100 Rabat, Maroc. mahdiaithoussa@yahoo.fr
Insights
Upper gastrointestinal haemorrhage (UGH) after heart surgery is rare but serious. This study found UGH occurred in 0.6% of patients, often linked to poor postoperative hemodynamics, despite antiacid prophylaxis.
Area of Science:
- Cardiology
- Gastroenterology
- Critical Care Medicine
Context:
- Upper gastrointestinal haemorrhage (UGH) following cardiac surgery presents a rare but significant clinical challenge.
- High mortality rates associated with UGH post-cardiac procedures necessitate further investigation into its incidence and outcomes.
Purpose:
- To determine the frequency and clinical outcomes of upper gastrointestinal haemorrhage (UGH) in patients undergoing open heart surgery.
- To analyze the causes, management, and mortality associated with UGH in this specific patient population.
Summary:
- A retrospective study of 1278 cardiac operations revealed an incidence of 0.6% for UGH.
- Gastro-duodenal ulcers were the primary cause (62%), with most cases managed medically (72%), though 25% required surgery.
- One patient died due to severe sepsis and multiple organ failure secondary to UGH.
Impact:
- Despite antiacid prophylaxis, UGH remains a complication with a poor prognosis.
- Postoperative hemodynamic instability appears to be a critical factor in the occurrence of UGH.
- Findings highlight the need for vigilant monitoring and management strategies for UGH in cardiac surgery patients.
Introduction:
Upper gastrointestinal haemorrhage (UGH) following cardiac surgery is infrequent with high mortality. The aim of this study is to compare the frequency and outcome of UGH in patients who had undergone open heart surgery at our institution.
Patients And Methods:
From January 1994 to December 2005, 1278 cardiac operations were performed. A systematic prophylaxis antiacid was used by antagonists of histaminic receptor (anti-H2, ranitidine 150 mg/12 h) in all patients. The diagnosis was based on clinical symptoms (haematemesis and/or melaena) in the postoperative period and confirmed by fibroscopy. We conducted a retrospective study of these patients.
Results:
Only 8 of the 1278 (0,6%) cardiac operations were complicated by UGH. Demographic data were reported in Table 1. The mean interval between surgery and UGH was 10+/-3,7 days (range 5,15 days). Gastro-duodenal ulcer was the most common cause of UGH in 5 patients (62%), ulcero-hemorrhagic eosophagitis was developed in one patient (12,5%), candidosic eosophagitis in one and multiple gastric ulcer in one patient (12,5%). Medical treatment was applied in 6 patients (72%) with successful result. Surgical intervention was necessary in 2 patients (25%). 2 patients had repeat gastrointestinal bleeding. One patient was died; he was recorded as having severe sepsis and multiple organ failure in addition to UGH.
Conclusion:
UGH in patients undergoing heart operation is rare but associated with poor prognosis despite antiacid prophylaxis. These complications occurred in patients who had in postoperative bad hemodynamic conditions.
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