1. Chirurgia Generale II e Centro di Chirurgia Mininvasiva, Università di Torino Prof. Mario MORINO 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

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

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

12. 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?

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

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

15. Conclusions The main indication of endoscopic hemoclips is control of active GI bleeding vs )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