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Chirurgische Therapiekonzepte bei oberer gastrointestinaler Blutung

Gastrointestinal bleeding — concepts of surgical therapy in the upper gastrointestinal tract

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Zusammenfassung

Obere gastrointestinale Blutungen sind das Leitsymptom einer Vielzahl von möglichen Differenzialdiagnosen, die noch immer mit einer erheblichen Mortalität einhergehen. An erster Stelle der Diagnostik steht die Endoskopie, welche bei der überwiegenden Mehrzahl der Fälle therapeutisch eingesetzt werden kann. Bei therapierefraktären bzw. rezidivierenden Ulkusblutungen ist die Rolle der Chirurgie unbestritten. Notfalloperationen bei oberer gastrointestinaler Blutung gehen jedoch mit einem deutlich erhöhten Mortalitätsrisiko einher, so dass die Möglichkeit einer früh elektiven Operation in die Überlegungen mit einbezogen werden sollte. Bei Blutungen, die im Zusammenhang mit komplexen pathogenetischen Prozessen stehen, stellt die Angiographie das entscheidende Diagnostikum dar. Dies gilt insbesondere für den Haemosuccus pancreaticus und die Hämobilie. Eine angiographische Blutstillung gelingt in den meisten Fällen und sollte zur Stabilisierung der Patienten eingesetzt werden. Aufgrund der ursächlichen Grundkrankheit ist jedoch für eine definitive Herdsanierung häufig eine chirurgische Intervention erforderlich.

Abstract

Bleeding of the upper gastrointestinal tract is the main symptom of a variety of possible conditions and still results in considerable mortality. Endoscopy is the first diagnostic modality, enabling rapid therapeutic intervention. In case of intractable or relapsing bleeding, surgery is often inevitable. However, emergency operations result in significantly higher mortality rates. Therefore the option of early elective surgical intervention should be considered for patients at increased risk of relapsing bleeding. If bleeding is symptomatic due to a complex underlying condition such as hemosuccus pancreaticus or hemobilia, angiography is now recognized as the definitive investigation. Angiographic hemostasis can be achieved in most cases. Due to the underlying condition, surgical management still remains the mainstay in treating these patients. This paper reviews surgical strategy in handling upper gastrointestinal bleeding.

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  1. Chirurgische Klinik, Universitätsklinikum der Heinrich-Heine-Universität Düsseldorf

    W. T. Knoefel & A. Rehders

  2. Chirurgische Klinik, Universitätsklinikum der Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225 , Düsseldorf

    W. T. Knoefel

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  2. A. Rehders
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Correspondence to W. T. Knoefel.

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Knoefel, W.T., Rehders, A. Chirurgische Therapiekonzepte bei oberer gastrointestinaler Blutung. Chirurg 77, 126–132 (2006). https://doi.org/10.1007/s00104-005-1141-8

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