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Gastrointestinale Komplikationen nach kardiochirurgischen Operationen

Gastrointestinal complications after thoracic surgery

  • Perioperative Medizin
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Gastrointestinale Komplikationen treten nach thoraxchirurgischen Eingriffen in bis zu 2,5% auf; betrachtet man Organtransplantatempfänger, so kann die Komplikationsrate 50% betragen. Häufig entstehen sekundäre Probleme bei den Patienten, die bereits per se einen komplizierten (post-)operativen Verlauf aufweisen. Die Kenntnis der häufigsten gastrointestinalen Manifestationen ist für jeden in der Thoraxchirurgie intensivmedizinisch tätigen Arzt wichtig.

Magen und Duodenum sind typische Lokalisationen von stressinduzierten Ulcera bzw. Blutungen, während im Kolon minderperfusionsbedingte Schäden als ischämische Kolitiden prädominieren. Herz- und lungentransplantierte Patienten leiden nicht selten unter schwer behandelbaren Motilitätsstörungen des Magens i. S. therapierefraktärer Gastroparesen. Akute Leberversagen treten insbesondere im Rahmen akuter Rechtsherzinsuffizienzen auf, während die sekundär sklerosierende Cholangitis zu den Spätkomplikationen intensivmedizinischer Behandlung zählt. Die genannten Entitäten werden hinsichtlich ihrer Pathophysiologie und der verfügbaren Therapieoptionen dargestellt.

Abstract

Gastrointestinal complications after thoracic surgery are common and occur in up to 2.5% of all patients and reach 50% after heart or lung transplantation. Knowledge of the most common gastrointestinal manifestations is important for thoracic surgery intensive care physicians.

Stress-induced ulcers and bleeding occur in stomach and duodenum, while colonic pathology predominantly consists of hypoperfusion-induced ischemic colitis. Organ transplant recipients suffer from refractory gastric hypomotility, i.e., gastroparesis. Complications of the hepatobiliary system include acute liver failure after right heart failure, while secondary sclerosing cholangitis is a relatively late complication of intensive care treatment. The typical gastrointestinal and hepatobiliary complications of cardiac surgery, the pathophysiological background and the available treatment options are discussed in this review.

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Authors and Affiliations

  1. Klinik für Gastroenterologie und Hepatologie, Zentrum für Innere Medizin Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland

    A. Dechêne, G. Gerken & A. Canbay

  2. Klinik für Allgemeinchirurgie, Viszeral- und Transplantationschirurgie, Zentrum für Chirurgie, Uniklinikum Essen, Essen, Deutschland

    G. Kaiser & A. Paul

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  1. A. Dechêne
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Correspondence to A. Dechêne.

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Dechêne, A., Kaiser, G., Paul, A. et al. Gastrointestinale Komplikationen nach kardiochirurgischen Operationen. Z Herz- Thorax- Gefäßchir 24, 28–36 (2010). https://doi.org/10.1007/s00398-009-0757-2

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