Pediatric surgery. Treatment of bleeding from dilated veins of the esophagus (most important)

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Pediatric surgery. Treatment of bleeding from dilated veins of the esophagus (most important)

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23. Treatment of bleeding from dilated veins of the esophagus

Conservative therapy in some cases leads to a stop of bleeding. After the diagnosis is established, the child is given a transfusion of blood products.

Sometimes 200-250 ml is required, and in case of severe unstoppable bleeding, 1,5-2 liters of blood products are transfused on the first day.

It is necessary to resort to direct transfusions more often, combining them with transfusion of conservative blood. With a hemostatic purpose, concentrated plasma, vikasol, pituitrin are administered; inside designate amino-caproic acid, adroxon, thrombin, hemostatic sponge.

The child is completely excluded from feeding by mouth, prescribing parenteral administration of an appropriate amount of liquid and vitamins (C and group B).

The infusion is carried out slowly, since a sharp overload of the vascular bed can lead to re-bleeding. An ice pack should be placed on the epigastric region.

All children are prescribed broad-spectrum antibiotics, detoxification therapy. Humidified oxygen is constantly given through nasal catheters to combat hypoxia. In case of severe intractable bleeding, hormonal therapy is included (prednisone 1-5 mg per 1 kg of body weight of the child per day).

Patients with an intrarenal form of portal hypertension for the prevention of liver failure are prescribed a 1% solution of glutamic acid. With successful conservative treatment after 4-6 hours, the general condition improves somewhat.

Blood transfusions are carried out 2-3 times a week, the administration of vitamins is continued. The course of antibiotics is completed on the 10-12th day. Hormonal drugs are canceled, gradually reducing their dosage.

Along with the specified conservative therapy, resort to an attempt to mechanically stop bleeding. This is achieved by introducing into the esophagus an obturating Blackmore probe, the inflated cuff of which presses the varicose veins of the esophagus.

The choice of the method of surgical treatment at the height of bleeding primarily depends on the general condition of the patient and on whether the child was operated on for portal hypertension earlier or bleeding occurred as one of the first manifestations of portal hypertension.

In children previously operated on for portal hypertension (splenectomy, creation of organ anastomoses), the operation is reduced to direct ligation of varicose veins of the esophagus or the cardia of the stomach. In patients who have not previously been operated on for portal hypertension syndrome, the operation should be aimed at reducing pressure in v. portae by reducing blood flow to esophageal varices.

In order to reduce blood flow to varicose veins of the esophagus, a modified Tanner operation is used - suturing the precordial veins without opening the lumen of the stomach.

Authors: Drozdov A.A., Drozdova M.V.

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