Gastroduodenal hemorrhage and perforation in the postoperative period

The distinction between stress ulceration and acute exacerbations of chronic peptic ulcer disease is rarely made in the context of postoperative hemorrhage or perforation of the upper part of the gastrointestinal tract. We reviewed our recent experience during a three and one-half year period with 31 emergency operations performed for gastroduodenal hemorrhage or perforation. Seven patients were convalescing from extensive surgical procedures unrelated to gastroduodenal ulcer disease at the time of hemorrhage or perforation. These complications tended to occur about one week after the initial operation. Six of these seven patients had duodenal ulcer disease; prior ulcer disease or current use of ulcerogenic drugs could be documented in all six. Only one of these seven patients had true stress ulceration. There were 143 patients with active peptic ulcer who underwent an extensive surgical procedure unrelated to ulcer disease. Three of these 143 patients required surgical intervention for complications of ulcer disease during the convalescent period. Our experience suggests that a common setting for emergency operations for peptic ulcer hemorrhage or perforation is during convalescence from an unrelated surgical procedure. A history of peptic ulcer disease or use of ulcerogenic agents should alert the surgeon to the possibility of postoperative hemorrhage or perforation. These complications most commonly reflect chronic duodenal ulcer disease or diathesis and not true stress ulceration.