3 hemmirage in surgury

Reading File

Finding Sources

Reading File

Here is a clear summary of the 3 types of haemorrhage in surgery, straight from Bailey and Love's Short Practice of Surgery (28th Edition):

3 Types of Haemorrhage in Surgery

1. Primary Haemorrhage

Bleeding that occurs immediately at the time of injury or surgery.
It happens during the operation itself.
Cause: direct vessel damage from the surgical procedure or trauma.

2. Reactionary Haemorrhage

Bleeding that is delayed, occurring within 24 hours postoperatively (some sources say 24-48 hours).
Causes:
- Dislodgement of a clot due to resuscitation, normalisation of blood pressure, or vasodilatation
- Slippage of a ligature (suture tie coming loose)
- A missed vessel injury where bleeding was temporarily stopped by vasoconstriction and hypotension - once blood pressure recovers postoperatively, bleeding resumes
Management: return to theatre to identify and control the bleeding vessel.

3. Secondary Haemorrhage

Bleeding that occurs 7-14 days after injury or surgery (days to weeks postoperatively).
Cause: sloughing (erosion) of a vessel wall, most commonly due to:
- Infection (most common) - infective organisms erode the vessel wall
- Pressure necrosis (e.g. from a poorly positioned drain)
- Malignancy eroding into a blood vessel
It is the most dangerous type because it is unexpected and can be torrential.

Quick Comparison Table

Type	Timing	Main Cause
Primary	At time of surgery/injury	Direct vessel injury
Reactionary	Within 24-48 hours	Clot dislodgement, slipped ligature, BP normalisation
Secondary	7-14 days later	Infection/necrosis eroding vessel wall

Key clinical point: Haemorrhage is treated by arresting the bleeding, not by fluid resuscitation alone. Repeated volume resuscitation without stopping the source leads to coagulopathy, acidosis, and hypothermia - the "lethal triad."

- Bailey and Love's Short Practice of Surgery, 28th Ed., pp. 36-38

This is a shared conversation. Sign in to Orris to start your own chat.