Endoscopic management of anastomotic bleeding in the ileal pouch with staples removal and clipping

Journal of Coloproctology - Tập 33 - Trang 39-41 - 2013
Xian-rui Wu1,2, Nan Lan2, Bo Shen3
1Department of Colorectal Surgery; The Cleveland Clinic Foundation; Cleveland USA
2Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
3Department of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, Cleveland, USA

Tóm tắt

Abstract Objective Postoperative pouch bleeding is a rare but detrimental complication following ileal pouch surgery. It is usually self-limited, however continuous bleeding requires inter- vention. There is limited published data on its management. Design Ileoscopy via stoma for loop ileostomy and pouchoscopy via anus for ileal pouch were performed under sedation for the purpose of diagnosis and management of postop- erative bleeding. Results Ileoscopy demonstrated a large, long blood clot in the lumen of efferent limb, but no sign of active bleeding was identified. Pouchoscopy showed that lumen of pouch body as well as afferent limb was filled with maroon-colored liquid stool. Pouch and neo-terminal ileum mucosa was normal. Two dislodged staples at the anastomotic line with sharp tips towards the lumen were found, with activating bleeding at one site. The staples were re- moved by biopsy forceps, and active bleeding was successfully controlled by the deploy- ment of one endoclip. Conclusions We reported the first case that postoperative pouch bleeding, which was caused by dislodged staples, was successfully managed by endoscopic removal of the staples com- bined with clipping.

Tài liệu tham khảo

Lian, 2008, Clinical features and management of postoperative pouch bleeding after ileal pouch-anal anastomosis (IPAA), J Gastrointest Surg, 12, 1991, 10.1007/s11605-008-0611-y Lustosa, 2001, Stapled versus handsewn methods for colorectal anastomosis surgery, Cochrane Database Syst Rev, CD003144 Neutzling, 2012, Stapled versus handsewn methods for colorectal anastomosis surgery, Cochrane Database Syst Rev, 2, CD003144 Perez, 2007, Endoscopic management of postoperative stapled colorectal anastomosis hemorrhage, Tech Coloproctol, 11, 64, 10.1007/s10151-007-0330-5 Sung, 2007, Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta- analysis, Gut, 56, 1364, 10.1136/gut.2007.123976
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Thông tin xuất bản

Journal of Coloproctology

Tập 33

39-41

Thông tin tác giả