Postoperative hemorrhagic gastritis

1. 1. The clinical histories of 9 patients who developed hemorrhagic gastritis during postoperative convalescence are summarized. 2. 2. Commonly observed antecedents to this condition are infection, tracheostomy, wound dehiscence, and the use of broad-spectrum antibiotics. Apparently unimportant factors are acid peptic juice, transfusion, shock, allergy, and presence of a nasogastric tube. No systemic bleeding tendencies were noted. 3. 3. Pathologic changes of hemorrhagic gastritis consist of bleeding under, into, and through intact mucosa. Mural edema and vascular congestion are prominent. This picture is distinct from that seen in erosive gastritis. 4. 4. A theoretical mechanism for the production of these changes is proposed which consists of ischemia secondary to erythrocyte sludging or arteriovenous shunting of blood away from the mucosa. Capillary integrity is lost as a result of hypoxia. 5. 5. No entirely satisfactory treatment has been evolved. Local hypothermia seems to slow, but not stop, the bleeding. Partial gastrectomy sometimes halts the hemorrhage. Total gastric excision solves the blood loss problem, but is an extensive operation poorly tolerated by patients in critical condition. Steroids have been reported to be effective.