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Surgery for Gastrointestinal Bleed
The most common causes of gastrointestinal bleed, manifested as vomitingof bright red blood or altered blood include – Gastric/ Duodenalulcer, Esophago gastric varices ( due to liver cirrhosis ),Esophageal / Gastric Cancer, Mallory weiss tear ( which occurs due toincessant vomiting) . The causes of bleed from the lower gastrointestinal tract includecarcinoma colon, diverticular disease of the colon or vascularabnormalities.
Theinitial treatment would include administration of intravenous fluidsand blood to improve and normalise the blood pressure. This will needadmission and monitoring in the ICU. Once the patient is stable anendoscopy is done to find out the cause of bleed. Many a timeendoscopy can help in controlling the bleed – with the applicationof clips / injections . When endoscopic treatment fails or ifbleeding continues, surgery would be the best option and depends onthe cause of bleed, and timing of surgery can be emergency, semielective or delayed.
Gastric/ Duodenal Ulcers
Largeulcers in the stomach usually will need resection / removal of thatpart of stomach to stop the bleed and also eliminate the small riskof cancer arising from this ulcer. In case the ulcer bleed is in theduodenum, the duodenum can be opened and the bleeding ulcer oversewnto control the bleed.
Cirrhosisis the commonest cause of variceal bleed – where blood vessels(veins) in the esophagus and stomach become engorged and dilated andbleed profusely. The surgical options include creation of a portosystemic shunt, that creates a sort of bypass between the portal andsystemic circulation and thus reduces the pressure in the veins.Another option at surgery is to isolate all the vessels to the lowerend of esophagus and stomach and control them, a procedure calledesophagogastric devascularisation.
Colonicbleed most commonly occurs from diverticulosis of the colon. Thiswould need am emergency or semi elective segmental resection of theinvolved colon. Cancer of the colon usually causes a slow bleed andits possible to complete full evaluation before proceeding with aplanned surgery. Inflammatory bowel diseases namely – UlcerativeColitis and Crohn’s disease may also cause significant bleed andrequire a colectomy on an urgent basis. Vascular anomalies are animportant cause of bleed from the lower gastrointestinal tract andcan be dealt with appropriately.