Gastrointestinal Bleeding in Neurosurgical Patient.

Koh, Seng Yun; Hong, Soon Ki; Han, Yong Pyo; Hu, Chul

Original Article

Journal of Korean Neurosurgical Society 1988;17(6): 1303-1308.

Seng Yun Koh, Soon Ki Hong, Yong Pyo Han, Chul Hu

Department of Neurosurgery, Yonsei University, Wonju College of Medicine, Wonju, Korea.

ABSTRACT

After the definition of Cushing's ulcer, it is well recognized that neurosurgical patients have the high risk of acute gastrointestinal bleeding, especially in severe head trauma. Acute gastrointestinal bleeding after burn, respiratory failure, hepatic failure, renal failure and sepsis as "stress ulcer" also were studied. The prevention and management of bleeding was discussed in medico-surgical field for several years. Despite of these regimen, the prognosis of the bleeding have not significantly improved and bleeding affected the patient's outcome more than initial neurosurgical intervention. The authors experienced 25 cases of acute gastrointestinal bleeding among our neurosurgical patients between January, 1984 to June, 1988. We analysed these patients respectively and concluded as follows: 1) The incidence of acute gastrointestinal bleeding was 0.61%. 2) The bleeding developed on 12th day, average, and clinical manifestation were anemia, hematemesis and melena in order of frequency within the first 4-week in almost all cases. 3) The initial neurological sign such Glasgow Coma Scale may well predict the hallmark to suspect the acute gastrointestinal bleeding. 4) The systemic insults such as shock, renal failure, hepatic failure, respiratory failure and sepsis significantly affected to re-bleeding chance and rendered the patient's outcome poorer. 5) The overall mortality due to gastrointestinal bleeding was 32% and the operative mortality was 50%.