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Bleeding and early obstruction after laparoscopic gastric bypass
Surgery for Obesity and Related Diseases 1 (2005) 450
Letter to the editor Bleeding and early obstruction after laparoscopic gastric bypass To the Editor: I found the article by Spaw and Husted in Surgery for Obesity and Related Diseases interesting [1]. I have previously reported on 2 patients who had an apparent brief episode of gastrointestinal bleeding that resulted in an obstructive blood clot at the jejunojejunostomy and produced intermittent bowel obstruction in 1 patient and sudden total obstruction at the jejunojejunostomy in the second [2]. Unfortunately, both patients died after celiotomy to correct the problem. It was not clear, in either case, where the bleeding had occurred. There was no change, in either patient, in the hemoglobin or hematocrit postoperatively and no other evidence of gastrointestinal bleeding. Both patients had undergone an initially uneventful open Roux-en-Y gastric bypass. At reoperation, only a local firm, rubbery blood clot was discovered, without any other evidence of gastrointestinal blood. Both patients had been taking enoxaparin pro-
phylaxis on a body mass index-based regimen every 12 hours. I would stress the importance of my observations, as well as the present authors’, in remembering that a cause of early bowel obstruction (within the first few days) can be blood clot with or without other clinical evidence of gastrointestinal bleeding. Although the present authors reported success with early reoperation, this can be a lethal event. Thomas S. Helling, M.D. Department of Surgery University of Missouri-Kansas City School of Medicine Kansas City, Missouri References [1] Spaw AT, Husted JD. Bleeding after laparoscopic gastric bypass: Case report and literature review. Surg Obes Relat Dis 2005;1:99 –104. [2] Helling TS. The lethality of obstructing hematoma at the jejunojejunostomy after Roux-en-Y gastric bypass. Obes Surg 2005;15:290 –1.
doi:10.1016/j.soard.2005.05.002
1550-7289/05/$ – see front matter © 2005 American Society for Bariatric Surgery. All rights reserved.
Letter to the editor Bleeding and early obstruction after laparoscopic gastric bypass To the Editor: I found the article by Spaw and Husted in Surgery for Obesity and Related Diseases interesting [1]. I have previously reported on 2 patients who had an apparent brief episode of gastrointestinal bleeding that resulted in an obstructive blood clot at the jejunojejunostomy and produced intermittent bowel obstruction in 1 patient and sudden total obstruction at the jejunojejunostomy in the second [2]. Unfortunately, both patients died after celiotomy to correct the problem. It was not clear, in either case, where the bleeding had occurred. There was no change, in either patient, in the hemoglobin or hematocrit postoperatively and no other evidence of gastrointestinal bleeding. Both patients had undergone an initially uneventful open Roux-en-Y gastric bypass. At reoperation, only a local firm, rubbery blood clot was discovered, without any other evidence of gastrointestinal blood. Both patients had been taking enoxaparin pro-
phylaxis on a body mass index-based regimen every 12 hours. I would stress the importance of my observations, as well as the present authors’, in remembering that a cause of early bowel obstruction (within the first few days) can be blood clot with or without other clinical evidence of gastrointestinal bleeding. Although the present authors reported success with early reoperation, this can be a lethal event. Thomas S. Helling, M.D. Department of Surgery University of Missouri-Kansas City School of Medicine Kansas City, Missouri References [1] Spaw AT, Husted JD. Bleeding after laparoscopic gastric bypass: Case report and literature review. Surg Obes Relat Dis 2005;1:99 –104. [2] Helling TS. The lethality of obstructing hematoma at the jejunojejunostomy after Roux-en-Y gastric bypass. Obes Surg 2005;15:290 –1.
doi:10.1016/j.soard.2005.05.002
1550-7289/05/$ – see front matter © 2005 American Society for Bariatric Surgery. All rights reserved.