Hemorragia en anastomosis intestinales y cólicas. Manejo terapéutico y sus complicaciones / Postoperative small bowel and colonic anastomotic bleeding. Therapeutic management and complications

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

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

Postoperative small bowel and colonic anastomotic bleeding. Therapeutic management and complications.

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%). 4 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.