I have operated a case of post gastrojejunostomy patient. He had huge projectile bilious vomiting with efferent loop obstruction and afferent loop syndrome. During surgery, I found excessive bleeding tendency. What may be the cause?
Efferent loop obstruction is usually a mechanical problem.Bleeding is not usually encountered unless there is a different pathology.
Reddy@ Thanks for your response. Is it possible in disturbances of Vit-K absorption and thus to this defect?
Regarding the illustration you y had provided,, the afferent loop is long,, the anastomosis is anit-peristatic.. both increases the incidence of afferent loop obstruction.
Bleeding in the site of previous surgery?? from the current inflammatory process and adhesions.
V.K deficiency from prolonged fasting and malnutrition could be a cause of general disturbance in coagulation profile,, which will be obvious from the start of operation in skin incision.
Taha@ Thank you for your observation and opinion. Yes the increased bleeding tendency was from skin incision (upper midline). It was separate from previous incision (rt paramedian).
I think there may had a coagulation defect as of in obstructive jaundice. Bile salt could not be passed to terminal ileum, thus defect in Vit-K (fat soluable) absorption.
The only condition i can figure is the reduction of Vit-K absorption caused by the obstruction preventing the bile salt to reach ileum.
Did you do any labtests concerning coagulation? I've had an obstructieve patient after gastric bypass who suffered from an cecal volvulus. She had a completly disrupted coagulation pathway for which we did not find an reasonable explanation.
Prevention is the best.One must avoid the efferent obstruction and blind afferent loop syndrome(ALS) by adopting the basic principles of GI Surgery.However in this case one can predict coagulation disorder only in presence of a very longstanding and long loop afferent loop syndrome(chronic ALS) and not if in case it has been an early(ALS) complication of GJ in GOO.
Guilherme Silva@ as there was efferent loop obstruction, bile salt was prevented to pass into terminal ileum.
Guido Jutten @ unfortunately I did not do any lab test regarding coagulation profile like prothrombin time. I found it only during surgery. A suspicion struck on my mind regarding it. I request future researchers to pay head on it for evaluation.
Ajaz Ahmad Malik @ The surgery was done about 30 years back by an incompetent surgeon. I had no scope of intervention at time and the procedures. I appreciate your valuable comment.
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