Transcript CASO CLINICO

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)
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?
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