Early complications after gastric surgery

The nature and extent of early complications depends largely on operative intervention than on the underlying disease.
Postoperative bleeding can occur because the arteries in the anastomosis after surgery resection
stomach or gastroenterostomy or, less frequently viewed from stomach ulcer, or from syezjinskaya cancer after palliative operations gastroenterostomy.
At the early postoperative gastrointestinal bleedings shown washing stomach small amounts of water temperature 50 C or solution 0,15% iron chloride. You must monitor the performance of hemoglobin and hematocrit. Their changes to define indications for use hemostatic (50,0-100,0) or substitution (250,0-500,0) doses of blood transfusions.
In late postoperative gastrointestinal bleedings we can talk about bleeding from ulcers duodenal ulcer after surgery resection of the stomach to turn it off. In this case, bloody vomiting, but there are symptoms of internal bleeding and tarry stool. Shown hemostatic and substitution blood transfusion.
If conservative measures to halt gastrointestinal bleeding prove ineffective, it shows the operation of gastrotomy to find the source of bleeding and its liquidation.
Postoperative atony of the stomach. The origin of postoperative atony gastric stump important role is played by two groups of reasons: mechanical and functional. The former include acute swelling of the mucous membrane of the stomach in the anastomosis, rarely occurring invagination outlet loop cancer in the gastric stump and too narrow opening of the anastomosis. The second group belongs transient blockade vagus with motility disorders of the stomach.
The first symptom of the developing gastric atony is the reduction of daily diuresis to 200-400 ml with the following development chloroprene azotemii, disturbed electrolyte balance, which is manifested by gipohloremia and hypokalaemia. It is proved that if the postoperative atony stomach is a potassium deficiency, which causes muscle weakness, exhaustion, atony intestines, oliguria, blood clots, heart failure. Hypokalemia is developing quickly, however, is the loss of chlorine ions and accumulation of sodium ions, which leads to alkalosis.
All this leads to a daily control serum and urine potassium ions and chlorine and the introduction of intravenous solutions of salts of potassium and sodium. These injections promote alignment gipohloremichesky (extrarenally) azotemii. It is necessary to avoid the introduction of excess potassium.
Bowel obstruction. After resection of the stomach in a few days or in a few years may be intussusception jejunum in the stomach, and took root in the stomach, intestinal loop swells and forms inside the stomach palpable "tumor". Check it out here more often occurs acutely, and its accompanying symptoms of high gastric or gastrointestinal obstruction: the collapse, vomiting with some blood or bile, symptoms of peritonitis from the perforation. The importance of x-ray contrast research becomes obvious. Treatment - emergency surgery, attempt diagonali and with the failure of its resection established part of the intestine.
Violation of patency of the gastro-intestinal anastomosis can occur due to inversion leads or discharge loop jejunum by 180 or 360 degrees. Symptoms of inversion is very similar to the above with intussusception. Treatment - operative and is deploying inversion of the intestinal loops, or in releasing her from the place of infringement. When necrosis loops of intestine shown resection deathly changed its part (M. M. Levin, 1961; M. E. Komakhidze and T. I. score, 1963).
Jaundice after gastric surgery. Develops within a few days after surgery, can be caused by two reasons: 1) the obstruction of the common bile duct in the bandaging his or crossing at the level of the upper edge of the duodenum and 2) small bleeding and increased destruction of red blood cells, leading to the increase of free bilirubin serum (resorption jaundice). Mechanical jaundice every day will increase, which will not happen when resorption jaundice. Mechanical jaundice is the indication for emergency surgery to restore the patency of the bile duct.
Vicious circle (Circulus vitiosus). A vicious circle is called a condition in which stomach contents if there gastrojejunostomy passes from the stomach through the gatekeeper to the duodenum in leading knee loop jejunum, participating in formation of the anastomosis. Hence, when there is an obstacle in the anastomosis to move the contents of the stomach into the distal part of the loop jejunum it returns again to the stomach.
When gastrojejunostomy with the brown enteroanastomosis the mechanism of formation of a vicious circle will be somewhat different: the food from the stomach quickly turns into a leading knee loop jejunum, forming anastomosis, and squeezes the inter-intestinal anastomosis, leading to reverse the flow of gastric contents in the stomach.
In clinical symptoms that have a lot in common with the above phenomena high obstruction, dominated by the gradual emergence of a feeling of heaviness in the stomach, turning into a feeling of bloating, excessive vomiting undigested food. Contrast x-ray examination of the stomach establishes the true cause high obstruction.
Treatment - prompt, aimed at eliminating obstruction.