Welling R E, Rath R, Albers J E, Glaser R S
Arch Surg. 1986 Oct;121(10):1178-80. doi: 10.1001/archsurg.1986.01400100090017.
From 1975 to 1985, a total of 1596 coronary artery bypasses or valve replacements resulted in 18 gastrointestinal tract complications in 16 patients at Good Samaritan Hospital in Cincinnati. Twelve patients were treated surgically (hemorrhagic duodenal ulcer, one patient; perforated duodenal ulcer, one patient; cholecystitis: acalculous, gangrenous, two patients, and calculus, one patient; perforated cecum, one patient; ischemic colitis, one patient; and perforated diverticulitis of the colon, five patients). Six patients were treated conservatively by either nasogastric intubation or nothing by mouth and intravenous therapy (ileus, three patients; acute sigmoid diverticulitis, one patient; and active peptic ulcer disease, two patients). Multisystem failure caused two deaths. The etiology of hollow viscus complications seems to be related to a low-flow state, impairing normal tissue perfusion that can initiate an ischemic change. This change can lead to acute inflammation, perforation, or both or late stricture. When evidence of an acute abdominal disorder is observed or when conservative treatment falls to alleviate symptoms, prompt surgical intervention should be performed.
1975年至1985年期间，在辛辛那提市的撒玛利亚医院，共进行了1596例冠状动脉搭桥术或瓣膜置换术，16名患者出现了18例胃肠道并发症。12名患者接受了手术治疗（出血性十二指肠溃疡1例；穿孔性十二指肠溃疡1例；胆囊炎：无结石性、坏疽性2例，结石性1例；盲肠穿孔1例；缺血性结肠炎1例；结肠穿孔性憩室炎5例）。6名患者通过鼻胃管插管或禁食及静脉治疗进行保守治疗（肠梗阻3例；急性乙状结肠憩室炎1例；活动性消化性溃疡病2例）。多系统衰竭导致2例死亡。中空脏器并发症的病因似乎与低流量状态有关，这会损害正常组织灌注，从而引发缺血性改变。这种改变可导致急性炎症、穿孔，或两者兼而有之，或后期出现狭窄。当观察到急性腹部疾病的迹象或保守治疗无法缓解症状时，应立即进行手术干预。
