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Chirurgia Generale II e Centro di Chirurgia Mininvasiva , Università di Torino

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

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Chirurgia Generale II e Centro di Chirurgia Mininvasiva , Università di Torino

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  1. 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

  2. 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)

  3. Colonoscopy

  4. Abdominal CT scan

  5. Abdominal CT scan

  6. Abdominal CT scan

  7. Chest X-ray

  8. Rectal cancer Treatment: laparoscopic anterior resection

  9. 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.

  10. ...and a CT scan

  11. 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?

  12. Flexible endoscopy Haemorrhage from the stapler line Endoscopic hemoclips Haemorrhage stopped immediatelly

  13. The subsequent postoperative course has been uneventful (at the last control: Hb 9.6 mg/dl) and the patient was discharged on 17th day.

  14. 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

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