Hemorragia digestiva baixa após biópsia prostática transretal: relato de caso / Rectal haemorrhage after prostate biopsy: a case report

Desde a década de 30, mais especificamente em 1937, Astraldi introduziu a via retal como padrão-ouro para realização de biópsias prostáticas. Desde então, esse procedimento tem se mostrado seguro e com baixas taxas de complicações graves. Em vários estudos publicados recentemente, a hematospermia se mostrou a complicação mais frequente, seguida pela hematúria e em terceiro lugar pelo sangramento retal. Relatamos, neste artigo, o caso de um paciente submetido a biópsias prostáticas por via retal, que evoluiu com sangramento grave, logo após a punção, com repercussão hemodinâmica, necessitando de intervenção endoscópica para bloqueio da hemorragia.

Bowel preparation for colonoscopy: comparison of mannitol and sodium phosphate: results of a prospective randomized study

METHOD: Eighty patients were prospectively randomized for precolonoscopic cleansing either with 750ml of 10 percent mannitol (Group M) or 180ml of a sodium phosphate preparation (Group NaP). Laboratory examinations before and after preparation on all patients included hemoglobin, hematocrit, sodium, potassium, phosphorous, calcium and serum osmolarity. A questionnaire was used to assess undesirable side effects and patient tolerance to the solution. The quality of preparation was assessed by the endoscopist who was unaware of the solution employed. RESULTS: Statistically significant changes were verified in serum sodium, phosphorous, potassium and calcium between the two groups, but no clinical symptoms were observed. There were no significant differences in the frequency of side effects studied. Six of the eight patients in Group NaP who had taken mannitol for a previous colonoscopy claimed better acceptance of the sodium phosphate solution. The endoscopic-blinded trial reported excellent or good bowel preparation in 85 percent prepared with sodium phosphate versus 82.5 percent for mannitol (p=0.37). CONCLUSIONS: Quality of preparation and frequency of side effects was similar in the two solutions. The smaller volume of sodium phosphate necessary for preparation seems to be related to its favorable acceptance. Nevertheless, the retention of sodium and phosphate ions contraindicates the use of sodium phosphate in patients with renal failure, cirrhosis, ascites, and heart failure.