A Clinical Study on Intraoperative Massive Bleeding in Gastroenterological Surgery

Fumio Futagami, Takukazu Nagakawa, Hirohisa Kitagawa, Masato Kayahara, Tetsuo Ohta, Keiichi Ueno, Kouichi Miwa

Second Department of Surgery, Kanazawa University School of Medicine

Sixty-four patients with intraoperative massive bleeding of more than 5,000 ml in gastroenterological surgery over the past 10 years were evaluated. These patients were divided into two groups according to the volume of intraoperative blood loss: a bleeding group (5,000∼10,000 ml, n=46) and an ultrableeding group (more than 10,000 ml, n=18). About 90 per cent of all patients in both groups had malignant diseases. The total transfusion volume almost corresponded to blood loss and half of it was composed of fresh frozen plasma. Only one patient was suspected of having post-transfusion hepatitis. A significant difference between the two groups was seen in the average speed of bleeding and was reflected in a difference in the drop in blood pressure and hemoglobin level. Although after the operation, a tendency of tachycardia, marked thrombocytopenia and liver dysfunction was seen in both groups, and a tendency of hepato-renal failure was observed particularly in the ultrableeding group, the patients recovered within a week. Grades of liver dysfunction were affected by the volume of blood loss. DIC was noticed among postoperative complications. All patients who received platelet transfusion were saved from DIC. This funding suggests that active platelet transfusion is necessary in intraoperative massive bleeding.

Key words
intraoperative massive bleeding, intraoperative blood transfusion, liver dysfunction, disseminated intravascular coagulation, platelet

Reprint requests
Fumio Futagami Department of Surgery, Kanazawa Red Cross Hospital
2-251 Minma, Kanazawa City, 921-8162 JAPAN

Accepted
March 11, 1998

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