An infrequent but dramatic and potentially catastrophic complication of gastrointestinal surgery is massive postoperative hemorrhage. Massive hemorrhage is defined as a sudden massive continuing hemorrhage into the upper gastrointestinal tract or free peritoneal cavity, with the classic picture of collapse: pallor, sweating, air hunger, hypotension, tachycardia, acute anemia, diminished blood volume, and reduced hematocrit. The recognition of this disaster must be prompt, and the therapy must be immediate and aggressive once the complication occurs. The responsibility is that of the internist as well as of the surgeon. It is necessary to control postoperative bleeding as rapidly as possible, for prolonged or repeated hemorrhage leads to various secondary complications to which the patient is obviously more susceptible after operation; he cannot compensate for blood loss as well as a normal person and goes into shock much more rapidly. Massive hemorrhage also predisposes patients with preexisting coronary insufficiency to myocardial infarction. Wound
Milch E, Lipp WF, Aaron AH. THE "TEST OF TRANSFUSION" AS APPLIED TO POSTOPERATIVE HEMORRHAGE. JAMA. 1954;156(13):1236–1238. doi:10.1001/jama.1954.02950130018004
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