Dieulafoy lesion after Roux-en-Y gastric bypass

Wade, Alexander D.; Kothari, Shanu N.

doi:10.1016/j.soard.2008.05.008

“…A Dieulafoy lesion in the gastric pouch has been reported previously and the lesion was treated successfully with electrocautery [44]. Our patient was successfully treated with a laparoscopic, transgastric endoscopy and argon plasma coagulation of the bleeding vessel.…”

Section: Discussionsupporting

confidence: 53%

Early and Late Abdominal Bleeding After Roux-en-Y Gastric Bypass: Sources and Tailored Therapeutic Strategies

Rabl

¹

,

Peeva

²

,

Prado

³

et al. 2011

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Bleeding is a potentially serious complication after Roux-en-Y gastric bypass (RYGB). Preventive measures and therapeutic strategies have not been adequately defined. We reviewed data on 742 consecutive patients treated at the University of California San Francisco to identify cases of early and late bleeding (less or greater than 30 days after surgery) after RYGB. Bleeding was defined as symptoms or signs of bleeding, associated with blood transfusion. We recorded patient characteristics, details of the operative technique, diagnostic approach, therapeutic strategies, and outcomes. Twenty-six patients (3.5%) had postoperative bleeding, which mostly occurred in the first 30 days postoperatively (N=19). Hematocrit decreased significantly from preoperative values (-5.2 ± 3.1 without bleeding vs. -14.8 ± 4.7 with, p<0.01). Type 2 diabetes was more prevalent in patients who had bleeding (58% vs. 32%, p=0.03). No other patient characteristics or details of the operative technique were associated with different rates of bleeding. Therapeutic intervention other than transfusion was needed for seven patients with early bleeding (36.8%) and for all patients with late bleeding. Four patients with early bleeding required reoperation. Early bleeding source was intraluminal in four patients, intraperitoneal in five, and self-limited and of unknown location in ten. Late bleeding occurred on average at 62.6 months (range, 5 to 300 months) after index surgery, five patients required reoperation, and the source was always intraluminal. Bleeding after RYGB may be from various anatomic sites; details of the operative technique were not associated with different rates of bleeding, and therapy should be tailored to suspected location of bleeding.

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“…These lesion are rarely detected during routine EGD [5,9], and the test would have probably been negative in the presented case during pre-operative EGD. The management of massive upper GI bleeding immediately following a bariatric procedure is controversial.…”

Section: Discussionmentioning

confidence: 67%

“…Typically presenting in older patients, it is believed to be an acquired phenomenon which was originally described separately by Gallard in 1884 (who initially labelled it as miliary aneurysm of the stomach) and by Georges Dieulafoy`s who believed it to be an early form of peptic ulceration which he called an exculceratio simplex [2,3]. Delayed bleeding from gastric Dieulafoy`s lesion has been previously described following Roux-en-Y gastric bypass for morbid obesity [4][5][6]. In this setting, the differential diagnosis includes early anastomotic marginal ulceration, staple line haemorrhage and even late erosive haemorrhage originating from outside the stomach [7].…”

Section: Introductionmentioning

confidence: 99%

Dieulafoy’s Lesion related massive Intraoperative Gastrointestinal Bleeding during single Anastomosis Gastric Bypass necessitating total Gastrectomy: A Case Report

Khalayleh¹

2017

Arch Surg Clin Res

0

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Introduction: Immediate postoperative gastrointestinal bleeding following bariatric bypass surgery is a major complication, and usually results from staple line hemorrhage or conventional gastro-esophageal causes. Dieulafoy`s lesion is a rare cause of gastrointestinal bleeding and is usually managed by endoscopic means. Herein we present a case of massive intraoperative bleeding resulting from gastric Dieulafoy`s lesion single anastomosis gastric bypass surgery necessitating resection of the gastric pouch. This is the fi rst description of this complication, and the difference of such a lesion from the sporadic ones is discussed.Discussion: Gastric bypass surgery is an effective procedure for morbid obesity. The approach we have adopted for massive upper GI hemorrhage in the immediate postoperative period should be distinguished from delayed bleeding after gastric bypass. In these latter cases, marginal ulceration is more common than bleeding from the remnant gastric pouch. It is also likely that bleeding from a Dieulafoy`s lesion following gastric bypass surgery represents a different disease compared to other Dieulafoy`s cases.Conclusion: This is the fi rst description of an intraoperative Dieulafoy`s lesion bleeding during the conduct of a single anastomosis gastric bypass procedure which required gastric pouch resection. Such a lesion differs from sporadic Dieulafoy`s cases, and must be considered in every case of intraoperative bleeding during gastric bypass.

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“…This unusual case represents intraoperative bleeding from a Dieulafoy`s lesion. These lesion are rarely detected during routine EGD [5,9], and the test would have probably been negative in the presented case during pre-operative EGD. The management of massive upper GI bleeding immediately following a bariatric procedure is controversial.…”

Section: Discussionmentioning

confidence: 67%

Dieulafoy’s Lesion related massive Intraoperative Gastrointestinal Bleeding during single Anastomosis Gastric Bypass necessitating total Gastrectomy: A Case Report

Khalayleh¹

2017

Arch Surg Clin Res

1

0

View full text Add to dashboard Cite

Introduction: Immediate postoperative gastrointestinal bleeding following bariatric bypass surgery is a major complication, and usually results from staple line hemorrhage or conventional gastro-esophageal causes. Dieulafoy`s lesion is a rare cause of gastrointestinal bleeding and is usually managed by endoscopic means. Herein we present a case of massive intraoperative bleeding resulting from gastric Dieulafoy`s lesion single anastomosis gastric bypass surgery necessitating resection of the gastric pouch. This is the fi rst description of this complication, and the difference of such a lesion from the sporadic ones is discussed.Discussion: Gastric bypass surgery is an effective procedure for morbid obesity. The approach we have adopted for massive upper GI hemorrhage in the immediate postoperative period should be distinguished from delayed bleeding after gastric bypass. In these latter cases, marginal ulceration is more common than bleeding from the remnant gastric pouch. It is also likely that bleeding from a Dieulafoy`s lesion following gastric bypass surgery represents a different disease compared to other Dieulafoy`s cases.Conclusion: This is the fi rst description of an intraoperative Dieulafoy`s lesion bleeding during the conduct of a single anastomosis gastric bypass procedure which required gastric pouch resection. Such a lesion differs from sporadic Dieulafoy`s cases, and must be considered in every case of intraoperative bleeding during gastric bypass.

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Dieulafoy lesion after Roux-en-Y gastric bypass

Cited by 5 publications

References 10 publications

Early and Late Abdominal Bleeding After Roux-en-Y Gastric Bypass: Sources and Tailored Therapeutic Strategies

Early and Late Abdominal Bleeding After Roux-en-Y Gastric Bypass: Sources and Tailored Therapeutic Strategies

Dieulafoy’s Lesion related massive Intraoperative Gastrointestinal Bleeding during single Anastomosis Gastric Bypass necessitating total Gastrectomy: A Case Report

Dieulafoy’s Lesion related massive Intraoperative Gastrointestinal Bleeding during single Anastomosis Gastric Bypass necessitating total Gastrectomy: A Case Report

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