Upper gastrointestinal bleeding after bariatric surgery

Bleeding after bariatric surgery may occur during the operation or immediately after as a consequence of vascular or parenchymal injury related to laparoscopy or of failure after hemostasis at the suture line or anastomosis. Although the occurrence of bleeding is rare, it represents a true emergency and needs immediate diagnostic and therapeutic measures. Bleeding into the gastrointestinal tract causing hematemesis and/or melena is better assessed by endoscopy, whereas intraperitoneal bleeding is diagnosed by computed tomography. The first goal of treatment is to make the patient stable, whereas removal of the cause of bleeding is performed by endoscopic or radiological procedures after the diagnostic phase. When the patient remains unstable, treatment must be promptly established. Remedial surgery is the last resource of treatment. Delayed bleeding is related to peptic ulcer development and usually resolves with pharmacological and endoscopic treatment.