Step-by-step Management and Treatment Outcome of Bleeding Control for Anastomosis Site after Low Anterior Resection with Double Stapling Technique.
- Author:
Hyuk Mun KIM
1
;
Eung Jin SHIN
;
Ok Pyung SONG
;
Jae Joon KIM
;
Yong Seok JANG
;
Rae Kyung PARK
;
Moo Joon BAEK
Author Information
1. Colorectal Clinic, Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea. colon@schbc.ac.kr
- Publication Type:Original Article
- Keywords:
Rectal cancer;
Low anterior resection;
Hemorrhage;
Stapling
- MeSH:
Acute Kidney Injury;
Anal Canal;
Drainage;
Enema;
Female;
Hemorrhage*;
Hemostatics;
Humans;
Ileus;
Male;
Mortality;
Rectal Neoplasms;
Treatment Outcome*
- From:Journal of the Korean Society of Coloproctology
2005;21(6):390-395
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: This study reviews our experience with a step- by-step management approach of increasing aggressiveness and evaluates the treatment outcome for intraluminal hemorrhage. METHODS: The study group was comprised of patients who had experienced intraluminal hemorrhage after a low anterior resection with the double stapling technique from 1999 to 2003. The choice of management was selected according to our step-by-step management protocol, and the outcomes were evaluated for each step, lincluding mortality and complications. RESULTS: Nine patients (6 males and 3 females, mean age 55 years) were identified, the mean volume of packed RBC transfusion was 2 pints, and the mean distance of the anastomotic site from the anal verge was 6 cm. The median stapler size was 31 mm. The first step was cold saline irrigation and drainage; four of 9 patients were controlled. The second step was retention enema with topical hemostatics; one of remaining 5 patients stopped bleeding. The third step was colonoscopic hypertonic saline injection around the bleeding site with direct colonoscopic electrocauterization, two of remaining 4 patients were controlled. The last step was suturing the bleeding site through the anus, the remaining 2 patients stopped bleeding. One of the 9 patients developed leakage from the anastomotic site after the last step management, three of the 9 patients had long standing ileus, and one of the 9 patients developed acute renal failure after a massive transfusion. There were no postoperative deaths. CONCLUSIONS: It is safer and easier to control bleeding with step-by-step management system of increasing aggressiveness.
