[Relaparotomy for intra-abdominal hemorrhage]

On 36,536 abdominal operations, in 36 patients (0.1%) there was necessary to perform a relaparotomy due to intraabdominal hemorrhage, of whom in 28 patients this complication arised after emergency surgical interventions, while in 8 cases after elective surgery. The cause of bleeding in 26 patients were technical mistakes during the first intervention, in two the overdosage of anticoagulants, in other two a fibrinolysis, and in one patient haemophilia. In 5 patients the origin of the hemorrhage could not be verified at relaparotomy. Clinical picture of an intraabdominal bleeding depended on its acuity and extent; in 18 patients the massive bleeding manifested suddenly or by progressive development of heart failure. In 7 patients slow evolution of the blood loss manifested with anemia and intestinal paresis. Hemoperitoneum arised in 6 patients, but without anemia, and in the other five remaining patients, a circuscripted intraabdominal hematoma was formed. In 8 patients laparocentesis was diagnostically successful. (The re-laparotomy was lifesaving for 26 patients). 12 patients died. The authors believe that well knowning of parameters of central hemodynamics, together with prolonged paresis of the gut, hyperthermia and hyperleucocytosis it is possible to recognize the predominant signs of acute postoperative hemorrhage.