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. MORINO Chirurgia Generale II e Centro di Chirurgia Mininvasiva, Università di Torino Prof. Mario 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)
Rectal cancer Treatment: laparoscopic anterior resection
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?
Flexible endoscopy Haemorrhage from the stapler line Endoscopic hemoclips Haemorrhage stopped immediatelly
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 is • control of active GI bleeding • For lower GI, no standardized protocol (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