Introduction
Gut function is often impacted by surgical interventions, and postoperative gastrointestinal complications are common. Fortunately, most are minor and self-limited, but a number may be severe, and rarely, life threatening. Many of the complications can either be prevented or treated with proper prophylaxis and early recognition. Given the escalating use of bariatric surgery in the treatment of obese patients, this population is faced with unique postoperative issues.
Postoperative gastrointestinal bleeding
Postoperatively, gastrointestinal bleeding is an uncommon but potentially serious complication. Clinically significant bleeding occurs in 0.5–1% of patients in the acute postoperative setting [1,2]. The major causes of acute postoperative bleeding include stress ulceration, bleeding from an intestinal anastamosis, ischemic colitis, and bleeding from preexisting lesions such as gastroduodenal ulcers and diverticular disease. Gastrointestinal hemorrhage temporally remote from surgery occurs less commonly, but may be due to aortoenteric fistulae and recurrent or marginal ulcer disease.
Stress-related mucosal disease
Stress-related mucosal disease (SRMD), or stress-ulceration is
the most common cause of postoperative GI bleeding,
although its incidence has decreased with increased use of
prophylaxis since 1999 [3,4]. Stress ulcers are primarily
believed to be due to disturbances in the mucosal microcirculation,
with relative local hypoperfusion causing a loss of
mucosal integrity, an imbalance between aggressive and protective
factors and subsequently development of multiple gastric
erosions and ulcerations [5–7]. Suppressing gastric acid
secretion is currently the best way to protect against these
mucosal events; antisecretory agents have been employed successfully
for prophylaxis of SRMD in high-risk patients [8].