हेपेटोलॉजी और अग्नाशय विज्ञान

Bleeding after gastric bypass surgery. The possibility of using balloon enteroscopy in the postoperative period

Abstract

Solovyeva M O

One of the possible complications after bariatric surgery is
bleeding. within the majority of cases bleeding within the later
stages of the postoperative period are intraluminal, with
clinical manifestations of high gastrointestinal bleeding.
Among all bariatric procedures, the event of this complication
is more common after Roux-en-Y gastric bypass. Upper
endoscopy is that the diagnostic and treatment method of
choice, but only bleeding within the gastric pouch or within the
gastroenteroanastomosis may be stopped during this way.
If localization of bleeding is within the remnant stomach or
duodenum and little intestine, it's necessary to use more
advanced endoscopic procedures. Male patient, 44 years old
with BMI 43 kg/m2 and comorbidities (Diabetes Mellitus type
2, decompensated in patient receiving hypoglycemic drugs),
was undergone laparoscopic Roux-en-Y gastric bypass in
October 2014. During the year %EWL was 81%, there was
compensation of diabetes without medication (HbA1 4,9%). In
January 2015 he was hospitalized in an exceedingly clinic in
St. Petersburg with signs of upper gastrointestinal bleeding.
He includes a history of melena during the last 5 days with an
episode of syncope within the hospital day. Hemoglobin was
88 g/l. Upper endoscopy and colonoscopy were performed
without identification of source of bleeding. Drug therapy was
conducted. some days later the patient was transferred to our
hospital with no signs of ongoing bleeding. Balloon-assisted
enteroscopy was performed. peptic ulceration with no signs of
bleeding was visualized. Endoscopic hemostasis wasn???t
needed. The patient was discharged the following day.
Course of anti-ulcer therapy performed