Buscar en
Cirugía Española (English Edition)
Toda la web
Inicio Cirugía Española (English Edition)
Journal Information
Share
Share
Download PDF
More article options
ePub
Visits
...
Original article
Postoperative Small Bowel and Colonic Anastomotic Bleeding. Therapeutic Management and Complications
Hemorragia en anastomosis intestinales y cólicas. Manejo terapéutico y sus complicaciones
Visits
...
Elena Fernández de Sevilla Gómeza,
Corresponding author
efsevilla@gmail.com

Corresponding author.
, Francesc Vallribera Vallsa, Eloy Espin Basanya, Silvia Valverde Lahuertaa, Mercedes Pérez Lafuenteb, Antonio Segarra Medranob, Manel Armengol Carrascoa
a Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Vall d’Hebron, Barcelona, Spain
b Unidad de Angioradiología, Hospital Universitario Vall d’Hebron, Barcelona, Spain
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Tables (4)
Table 1. Type of Surgery Performed.
Table 2. Therapeutic Options for Anastomotic Bleeding.
Table 3. Data on Cases of Post-Angiographic Embolization Suture Dehiscence.
Table 4. Mortality After an Episode of Postoperative Bowel or Colonic Anastomotic Bleeding.
Show moreShow less
Abstract
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.

Keywords:
Surgical anastomosis
Gastrointestinal bleeding
Therapeutic embolization
Anastomotic leak
Resumen
Introducción

La hemorragia postoperatoria de una anastomosis intestinal o cólica (HPAIC) suele ser una complicación leve, manejada generalmente de forma conservadora. Otras opciones terapéuticas son la cirugía, la endoscopia y la embolización angiográfica. Nuestro objetivo es realizar un análisis descriptivo de las hemorragias anastomóticas postoperatorias en pacientes con anastomosis intestinales o cólicas, el tratamiento realizado y las complicaciones derivadas.

Pacientes y métodos

Estudio observacional retrospectivo, que incluye pacientes con HPAIC en el Servicio de Cirugía General y del Aparato Digestivo del Hospital Universitario Vall d’Hebron entre 2007 y 2012. Se han recogido las características de los pacientes, del tratamiento y las complicaciones según la opción terapéutica.

Resultados

Hallamos 44 casos de hemorragia anastomótica, siendo varones 25 (56,8%), con una media de edad de 68,2 años (R: 28-92). La caída media de hematocrito fue de 8 puntos (R: 0-17), presentando inestabilidad hemodinámica 13 pacientes (29,5%). Se realizó manejo conservador en 27 pacientes (61,4%), cirugía en 6 (13,6%), manejo endoscópico en 2 (4,5%) y embolización en 9 (20,5%). De los casos embolizados, 4 pacientes presentaron dehiscencia anastomótica (44,5%). La mortalidad fue de 13,6% (6 pacientes). Un total de 4 de las 6 muertes pertenecen al grupo embolizado.

Conclusiones

La mayoría de pacientes con HPAIC responden al tratamiento conservador. Cuando fracasa, existen diferentes opciones terapéuticas que incluyen la embolización angiográfica. En nuestra serie observamos una elevada incidencia de dehiscencia anastomótica postembolización, siendo necesario reevaluar el tipo de embolización así como sus indicaciones y contraindicaciones.

Palabras clave:
Anastomosis quirúrgica
Sangrado gastrointestinal
Embolización terapéutica
Dehiscencia de sutura

Article

These are the options to access the full texts of the publication Cirugía Española (English Edition)
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Cirugía Española (English Edition)

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
E-mail
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos