Introducere: Roux-en-Y gastric bypass (RYGB) este unul dintre cele mai utilizate procedee la nivel mondial în tratamentul obezitãåii. Acest
procedeu implicã alterarea anatomiei digestive. Hemoragia postoperatorie din stomacul exclus din tranzit, o complicaåie rarã, specificã
acestui procedeu comportã o ratã majorã de morbiditate æi mortalitate. Diagnosticul æi strategia curativã rãmân a fi nerezolvate.
Obiectivul: Stabilirea unui algoritm diagnostico-curativ la pacienåii cu hemoragie digestivã acutã în perioada postoperatorie precoce
dupã RYGB.
Material æi metode: Sunt relatate 12 cazuri (4,9%) clinice din 246 pacienåi supuæi RYGB pe perioada 2009-2018, care au dezvoltat
în perioada postoperatorie precoce hemoragie acutã digestivã. Vârsta a oscilat în limitele 32-58 ani, masa corporalã medie 105±7,4
kg, indicele masei corporale (IMC) a fost în limitele 39,9 ±1,8 kg/m2.
Rezultate: În 4 cazuri pe fundal de hemoragie a survenit dilatarea acutã gastricã, ce a necesitat intervenåie chirurgicalã cu montarea
gastrostomei parietale. În trei cazuri s-a dezvoltat o avalanæã de complicaåii consecutive dilatãrii acute gastrice, care au necesitat
intervenåii repetate.
Concluzii: Hemoragia acutã gastricã poate declanæa o serie de complicaåii consecutive, potenåial letale. Hemoragia din tranæa de
suturã mecanicã pare a fi factorul determinant în iniåierea dilatãrii acute gastrice.

Introduction: Among bariatric procedures, Roux-en-Y gastric bypass (RYGB) is the most performed surgical method worldwide
for the treatment of morbid obesity. This procedure implies alterations of the digestive system. Acute gastric bleeding, a rare
complication specific to this procedure, is a major risk of mortality. The diagnosis and curative strategy remain unsolved.
Purpose: Establishment of an algorithm for diagnosis and treatment for patients with acute gastric bleeding in the early postoperative
period after RYGB.
Materials and methods: We report on 12 cases (4,9%) from 246 patients undergoing RYGB during 2009-2018, that have developed
an acute gastric bleeding in the early postoperative period. Age was situated between 38 and 58 years, the mean body weight was
105±7,4 kg, and the average body mass index (BMI) prior to the surgery was 39,9±1,8 kg/m2.
Results: In 4 cases, acute gastric dilatation occurred after bleeding, requiring surgical intervention in form of percutaneous
gastrostomy. In 3 cases, a set of complications in addition to acute gastric dilatation required repeated interventions.
Conclusions: Acute gastric bleeding may trigger a set of consecutive complications, potentially deadly. Bleeding from the mechanical
suture trance seems to be the main factor in acute gastric dilatation initiation.