Postoperative Small Bowel and Colonic Anastomotic Bleeding. Therapeutic Management and Complications
| Autor: | Elena Fernández de Sevilla Gómez, Manel Armengol Carrasco, Antonio Segarra Medrano, Francesc Vallribera Valls, Eloy Espin Basany, Silvia Valverde Lahuerta, Mercedes Pérez Lafuente |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Gastrointestinal bleeding medicine.medical_specialty Colon medicine.medical_treatment Anastomotic Leak Postoperative Hemorrhage Anastomosis Hematocrit Colonic Diseases Surgical anastomosis Intestine Small Humans Medicine Embolization Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry General surgery Incidence (epidemiology) General Engineering Retrospective cohort study Middle Aged medicine.disease Embolization Therapeutic Surgery Female Gastrointestinal Hemorrhage business Complication |
| Zdroj: | Cirugía Española (English Edition). 92:463-467 |
| ISSN: | 2173-5077 |
| Popis: | Introduction Postoperative small bowel or colic anastomotic bleeding (PSCAB) is often a mild complication and is generally treated by a conservative approach. Other therapeutic options are surgery, endoscopic management and angiographic embolization. Our aim is to review our cases of postoperative anastomotic bleeding in patients with small bowel or colic anastomosis, with special attention to their treatment and complications. Patients and methods Observational retrospective study including patients with PSCAB in the department of General and Digestive Surgery in Vall d’Hebron University Hospital, between 2007 and 2012. Demographic and bleeding characteristics as well as therapeutic management were reviewed, including complications derived from the different therapeutic options. Results There were 44 cases of bleeding after performing small bowel or colic anastomosis, 25 patients were men (56.8%), with a mean age of 68.2 years (R: 28–92). The mean hematocrit decrease was 8 points (R: 0–17), and hemodynamic instability was detected in 13 patients (29.5%). A conservative management was undertaken in 27 patients (61.3%), surgery in 6 (13.6%), endoscopic treatment in 2 (4.5%) and embolization in 9 (20.5%). Four patients of cases treated with embolization presented anastomotic leak (44.5%). Mortality was 13.6% (6 patients). A total of 4 of 6 deaths were in the group of patients treated with embolization. Conclusions Most patients with PSCAB have a good response to conservative management. When there is failure of this approach, there are different therapeutic options, including angiographic embolization. In our series, we have seen a high incidence of post embolization anastomotic leak; further trials will be necessary to provide valuable evidence of the risk of this therapeutic option. |
| Databáze: | OpenAIRE |
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