Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-06-05T12:19:14.067Z Has data issue: false hasContentIssue false
  • English
  • Français

Gastrointestinal Bleeding After Craniotomy: A Retrospective Review of 518 Patients

Published online by Cambridge University Press:  18 September 2015

P. Muller ,
D. Jirsch ,
J. D'Sousa ,
C. Kerr  and
C. Knapp
P. Muller*
Affiliation:
Divisions of Neurosurgery and General Surgery, Department of Surgery, St. Michael's Hospital, Toronto and Department of Surgery, University of Toronto, Toronto
D. Jirsch
Affiliation:
Divisions of Neurosurgery and General Surgery, Department of Surgery, St. Michael's Hospital, Toronto and Department of Surgery, University of Toronto, Toronto
J. D'Sousa
Affiliation:
Divisions of Neurosurgery and General Surgery, Department of Surgery, St. Michael's Hospital, Toronto and Department of Surgery, University of Toronto, Toronto
C. Kerr
Affiliation:
Divisions of Neurosurgery and General Surgery, Department of Surgery, St. Michael's Hospital, Toronto and Department of Surgery, University of Toronto, Toronto
C. Knapp
Affiliation:
Divisions of Neurosurgery and General Surgery, Department of Surgery, St. Michael's Hospital, Toronto and Department of Surgery, University of Toronto, Toronto
*
St. Michael's Hospital, 38 Shuter St., Toronto, Ontario, Canada M5B 1A6
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

A retrospective review of the medical records of 518 patients who underwent craniotomy over a 3 year interval was carried out to determine the rate of gastrointestinal bleeding and its relationship to the Glasgow Coma Score. There were 288 [55.5%] males and 230 [44.5%] females in the series; the mean age was 51.5±18.9 years. Forty percent had brain tumours, 18% had subarachnoid hemorrhage, 14% had spontaneous intracerebral hemorrhage, 19% had head injury and 8% had other diagnoses. Forty-eight [9.3%] of the patients had significant gastrointestinal bleeding, the distribution of which was as follows: hematemesis [37/518], melena [11/518] and/or hematochezia [4/518]. A further 51 [9.8%] had evidence of “coffee ground emesis” only. Of those with a Glasgow Coma Score of <10, 21% had significant GI bleeding while only 7% of patients with a Glasgow Coma Score >10 had such a bleed [p<0.005]. Further analysis showed that the incidence of GI bleeding in patients who underwent craniotomy increased with decreasing GCS. GI bleeding did not correlate with age, sex, steroid administration or casual use of anti-ulcer medication.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 15 , Issue 4 , November 1988 , pp. 384 - 387
Copyright
Copyright © Canadian Neurological Sciences Federation 1988

References

REFERENCES

1.Bank, S. Stress ulcers — prevention of gastrointestinal bleeding in critical care units. Med J Australia 1985; 142: 517–521.CrossRefGoogle ScholarPubMed
2.Cheng, LY. Treatment of established stress ulcer disease. World J Surg 1981; 5: 235–40.CrossRefGoogle Scholar
3.Cushing, H. Peptic ulcers and the interbrain. Surg Gynecol Obstet 1932; 55: 1–34.Google Scholar
4.Greenberg, AG, Saik, RP, Bell, RH. Changing patterns of Gastrointestinal bleeding. Arch Surg 1985; 120: 341–344.CrossRefGoogle Scholar
5.Groll, A, Simon, JB, Wigle, RD, et al: Cimetidine prophylaxis for gastrointestinal bleeding in an intensive care unit. Gut 1986; 27: 135–140.CrossRefGoogle Scholar
6.Gudeman, SK, Wheeler, CB, Miller, JD, et al. Gastric secretory and mucosal injury response to severe head trauma. Neurosurgery 1983; 12: 175–179.CrossRefGoogle ScholarPubMed
7.Halloran, LG, Zfass, AM, Gayle, WE, et al. Prevention of acute gastrointestinal complications after severe head injury: a controlled study of cimetidine prophylaxis. Am J Surg 1980; 39: 44–48.CrossRefGoogle Scholar
8.Hastings, PR, Skillman, JJ, Bushnell, LS, et al. Antacid titration in the prevention of acute gastrointestinal bleeding: a controlled, randomized trial in 100 critically ill patients.? Engl J Med 1978; 298: 1041–1045.CrossRefGoogle ScholarPubMed
9.Idjadi, F, Robbins, R, Stahl, WM, et al. Prospective study of gastric secretion in stressed patients with intracranial injury. J Trauma 1971; 11: 681–688.CrossRefGoogle ScholarPubMed
10.Kamada, T, Fusamoto, H, Kawano, S, et al. Gastrointestinal bleeding following head injury: a clinical study of 433 cases. J Trauma 1977; 17: 44–47.CrossRefGoogle ScholarPubMed
11.Kamada, T, Fusamoto, H, Kawano, S, et al. Acute gastrointestinal lesions in head injury. Amer J Gastroenterol 1977; 68: 249–253.Google ScholarPubMed
12.Karch, SB. Upper gastrointestinal bleeding as a complication of intracranial disease. J Neurosurg 1977; 37: 27–29.CrossRefGoogle Scholar
13.Larson, MG, Koch, S, O’Dorisio, TM, et al. Gastric response to severe head injury. Amer J Surg 1984; 147: 97–105.CrossRefGoogle ScholarPubMed
14.Menguy, R. The prophylaxis of stress ulceration.? Engl J Med 1980; 302: 461–462.CrossRefGoogle ScholarPubMed
15.Muller, PJ, Jirsch, D, Knapp, C, et al. The incidence and distribution of stress GI bleeding in neurosurgical patients. Canad J Neurol Sci 1985; 12: 194. [abst.]Google Scholar
16.Priebe, HJ, Skillman, JJ, Bushnell, LS, et al. Antacid versus cimetidine in preventing acute gastrointestinal bleeding: A randomized trial in 75 critically ill patients.? Engl J Med 1980; 302: 426–430.CrossRefGoogle ScholarPubMed
17.Watt, CC, Clark, K. Gastric acidity in the comatose patient. J Neurosurg 1969; 30: 107–109.CrossRefGoogle Scholar