Una rara complicanza precoce delle anastomosi digestive meccaniche: l’emorragia.


Carmelo Sciumè, Girolamo Geraci, Franco Pisello, Francesco Li Volsi, Tiziana Facella, Giuseppe Modica

Ann. Ital. Chir., 2006; 77: 269-273

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INTRODUCTION: Bleeding from mechanical digestive anastomosis is an uncommon complication (0.9-3.2%) often selflimiting
but potentially lethal if not evidenced intraoperatively or in the immediate postoperative.
MATERIAL AND METHODS: The Authors retrospectively report incidence of anastomotic bleeding after stapled anastomosis
(11/163 = 6.7%) and analyse probable causes. In 6 of 11 patients (54%) intraoperative bleeding was stopped after
manual reinforce of anastomosis (3/6) or stopped spontaneously (3/6). In 5 patients (45%), 1 with gastro-jejunal anastomosis,
2 with ileo-colonic anastomosis and 2 with colo-rectal anastomosis, they used endoscopy and endoscopic treatment
in emergency.
RESULTS: All 5 patients were treated with endoscopic clerotherapy (NaCl 0.9% plus epinephrine 1:10000): in 4 (80%)
the Authors obtained hemostasis after the first treatment but in one of 2 cases ol ileo-colonic anastomosis (20%) the
bleeding relapsed and the patient was re-operated. In 1 patient with the self-limiting lower anastomotic bleeding was
associated to a Dieulafoy’s gastric ulcer, perendoscopic treated successfully. In summary 2 patients were resubmitted to
laparotomy, without evidence of source of bleeding.
CONCLUSIONS: In accord with literature, bleeding from mechanical digestive anastomosis is a rare complication, often
self-limiting (50-76%), that may be evidenced and treated early in intraoperative phase. Endoscopic examination may
have diagnostic (source and type) and therapeutic valence, is effective, with low intrinsic risk and can reach endoscopic
hemostasis without relaparotomy, except in case of rebleeding.