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)

Colonoscopy

Abdominal CT scan

Abdominal CT scan

Abdominal CT scan

Chest X-ray

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.

...and a CT scan

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