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Chirurgia Generale II e
Centro di Chirurgia Mininvasiva, Università di Torino
Prof. Mario MORINO
First International Meeting
Colorectal Bleeding: a Multidisciplinary Approach
31 March – 1 April, 2006
Turin, Italy
ENDOSCOPIC MANAGEMENT OF A RECTAL BLEEDING COMPLICATING
LAPAROSCOPIC ANTERIOR RESECTION
M.E. ALLAIX, R. RIMONDA, M. MORINOM.E. ALLAIX, R. RIMONDA, M. MORINO
Medical history
• M.L.
• Male, 46 years old• Tonsillectomy• Gastritis HP+ treated with antibiotics 2 years ago• In consequence of rectorrhage, the patient underwent:• Colonoscopy + biopsies: scissile polyp at the rectosigmoid junction 12 to 16 cm from the anal verge• Histopathologic diagnosis: moderately differentiated colonic adenocarcinoma
•CEA 1.9 ng/ml (<5.0); CA19-9 19 U/ml (<37)
Postoperative course•Initially regular
•P.O. DAY 8: massive rectal bleeding => Hb 7.5 g/dl, tachycardia, hypotension and sweat
Resuscitation + 4 blood transfusions...
After the blood transfusion and the medical treatment of the hypovolemic shock, the Hb
level was 9.7 mg/dl.
P.O. DAY 9: the patient complained persistence of rectorrhage, associated with hypotension and
tachycardia; at the haematologic exams, the Hb level progressively dropped down to 8.5 mg/dl.
WHICH TREATMENT?
Endoscopic hemoclips
Flexible endoscopy
Haemorrhage stopped immediatelly
Haemorrhage from the stapler line
The subsequent postoperative course has been uneventful (at the last control: Hb 9.6 mg/dl) and the patient was discharged on 17th day.
Conclusions
•The main indication of endoscopic hemoclips iscontrol of active GI bleeding•For lower GI, no standardized protocol (vs vs upper GI))•Limited postop bleeding are quiet frequent and usually stops spontaneously•Massive bleeding after colorectal surgery is unfrequent => few data about its management in the Literature