Perforated peptic ulcer after coronary bypass grafting two case reports

ABSTRACT

We are documenting cases with perforated peptic ulcer after coronary bypass grafting. Diagnosis is difficult in the immediate post-operative period. The clinical signs being misleading and interpretation of complementary investigations difficult. Therefore, the possibility of abdominal complications must be kept in mind, especially in patients with one or more predisposing factors. The following factors have an increase risk of abdominal complications previous history of gastrointestinal pathology [ulcer, gall stone, alcoholism] the nature of the underlying cardiac disease, cardiopulmonary bypass and, above all, peri and post-operative incidents; hypovolemia, low output syndrome, respiratory and infectious complications. The inappropriate use of vasoconstricting agents may also play a role. Majority of abdominal complications seem to be related to the ichaemia and anoxia in the splanchnic territory. This justifies certain prophylactic measures: strict selection of the patients, diagnosis and treatment of associated abdominal pathology before operation, prevention of low output states, respiratory and infectious complications and careful examination of the abdomen after operation to ensure the early diagnosis and treatment of complications, should they develop