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Case 120: Return to theatre

A 64 year old man had a subtotal gastrectomy for cancer earlier in the day. In HDU he required substantial IV filling and inotrope doses. The drain did not produce much blood.

1. What are the signs of post operative haemorrhage?

abdominal distension
peripheral shutdown
decreased urinary output
later - hypotension and hypovolaemic shock

2. Why did the drain not reveal the bleeding?

Because it blocked, possibly with clotted blood. Drains are often helpful, but not always. They have a tendency to give the wrong impression if relied upon.

Powerpoint presentation
Postoperative Care: Shock in the Surgical Patient