Gastrointestinal bleeding in cases of ruptured cerebral aneurysms

Abstract

Among 1,000 cases of patients undergoing direct surgery on cerebral aneurysms, two, showed clear signs of preoperative, and 19 cases showed postoperative gastrointestinal bleeding. We have made a clinical analysis of various aspects of the 19 cases in which the bleeding developed postoperatively. 1. Gastrointestinal bleeding was most frequent postoperatively in cases of AComA aneurysms (4.3%) and ICA aneurysms (2.0%), and less common in MCA and ACA aneurysm cases. 2. Gastrointestinal bleeding was most frequently seen in those cases operated on between the third and seventh days after the last subarachnoid haemorrhage (8.9%) and was more common in cases with a relatively poor preoperative grade. 3. The development of such bleeding in cases with a good preoperative grade was due to problems with the surgical operation in most cases, although the influence of vasospasm must not be ignored. The development of bleeding in cases with a poor preoperative grade is thought to be due primarily to vasospasm and transitory brain damage to the hypothalamus and the orbital portion of the anterior lobe due to a haematoma caused by aneurysm rupture. 4. First, the location of gastrointestinal bleeding should be determined endoscopically and, if haemostasis is not achieved by coagulation, then the desirability of surgery should be considered early. Abdominal surgery may be performed.

Effects of Progesterone on Intestinal Inflammatory Response and Mucosa Structure Alterations Following SAH in Male Rats

“…To better understand the alteration of the intestinal function and better conduct the efficacious treatment in the SAH patients, the study on the intestinal mucosa structure after SAH is urgent and warranted. The major changes of SAHinduced gastrointestinal function may include stress ulcer, gut motility dysfunction, disruption of gut barrier, and alterations of mucosal absorptive function [10,22]. In this study, we found that damage of intestinal mucosa occurred after SAH.…”

“…In addition, non-neurologic complications such as pulmonary edema and pneumonia [2,3], cardiac arrhythmia [4,5], electrolyte disturbance [6], hematologic change [7,8] also add to morbidity and mortality after SAH [9]. Besides those complications, gastrointestinal dysfunction could be frequently observed in the patients suffering from SAH [10]. Gastrointestinal dysfunction may initiate a cascade of intestinal events such as intestinal cytokine overproduction, increased intestinal permeability and translocation of intestinal bacteria and endotoxins [11,12].…”

The Inflammation in the Gut After Experimental Subarachnoid Hemorrhage

“…Besides those complications, gastrointestinal dysfunction could be frequently observed in the patients suffering from SAH. Dysfunction of the gastrointestinal tract leads to some symptoms such as gastrointestinal bleeding, gastric reflux, and decreased intestinal peristalsis, which could influence the outcome after SAH [15,16].…”

Clinical Potential of Immunotherapies in Subarachnoid Hemorrhage Treatment: Mechanistic Dissection of Innate and Adaptive Immune Responses

“…Stress-mediated gut dysbiosis can regulate T cell homeostasis, enhancing T lymphatic migration from the intestine to the brain and promoting pro-inflammatory responses, ultimately leading to unexpected clinical outcomes in ischemic stroke [ 152 ]. SAH patients are frequently accompanied by various gastrointestinal dysfunctions, including gastrointestinal bleeding, gastric reflux, and decreased intestinal peristalsis, which further exacerbate SAH prognosis [ 154 ]. The initiation of a cascade of intestinal dysfunction events, including over-production of intestinal cytokines, increased intestinal permeability and accelerated bacterial and endotoxin entry in the intestines [ 155 ], affect the function and integrity of remote organs, resulting in SIRS and multiple organ dysfunction syndrome.…”

“…The initiation of a cascade of intestinal dysfunction events, including over-production of intestinal cytokines, increased intestinal permeability and accelerated bacterial and endotoxin entry in the intestines [ 155 ], affect the function and integrity of remote organs, resulting in SIRS and multiple organ dysfunction syndrome. The dominant alterations of SAH-induced gastrointestinal dysfunction include stress ulcer formation, gut motility dysfunction, and gut barrier disruption [ 154 , 156 ]; however, gut dysbiosis-mediated immune responses post-SAH have not yet been fully investigated.…”