Massive Gastrointestinal Hemorrhage Following Side-to-Side Intestinal Anastomosis

BLIND loop and malabsorption syndromes have been implicated as a cause of anemia following side-to-side intestinal anastomosis.¹ Blood loss has been eliminated as the cause of anemia in most of these instances on the basis of absence of blood in the stools and the presence of macrocytic rather than microcytic, iron-deficiency anemia.² The incidence of anemia as a complication of side-to-side intestinal anastomosis is difficult to determine, but its occurrence has been well documented in a number of reports. Massive gastrointestinal hemorrhage following side-to-side intestinal anastomosis must occur even less frequently than other complications if one can judge from the paucity of reports of this problem. Clawson³ in 1953 reported a case with ulceration at the site of a previous side-to-side ileoileostomy. This patient demonstrated hypochromic, microcytic anemia as well as occult blood in the stool. Brief and Botsford,⁴ in 1963, reported a similar case as