The features and course of bile vomiting following gastric surgery

In a retrospective study 119 (9.1 per cent) of 1311 patients undergoing peptic ulcer surgery developed postoperative bile vomiting. Patients aged over 60 years at operation appeared particularly at risk. The sex distribution was equal. Operations that aim at reducing acid secretion had a similar incidence of vomiting, although the complication was not seen following 55 simple gastrojejunostomies. Vomiting developed within I month of operation in 39 per cent of patients, and 57 per cent suffered a significant degree of disability for 6-14 years after onset. Twenty-four per cent of patients underwent reoperation. Aetiological factors were gastric outlet obstruction and gastritis due to bile reflux; pre-existing constitutional and psychological abnormality seldom contributed significantly to the syndrome. It is concluded that bile vomiting as a persistent and disabling complication of gastric surgery demands objective physical and psychological assessment prior to a decision regarding management.