Annals of Coloproctology

Original Article

Benign GI diease,Benign diesease & IBD,Complication,Surgical technique

Efficacy and Safety of Endoscopic Clipping for Acute Anastomotic Bleeding After Colorectal Surgery: Ryun Kyong Ha, Kyung Su Han, Sung Sil Park, Dae Kyung Sohn, Chang Won Hong, Byung Chang Kim, Bun Kim; Ann Coloproctol. 2022;38(3):262-265. Published online October 26, 2021; DOI: https://doi.org/10.3393/ac.2021.00297.0042

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Purpose
Anastomotic bleeding after colorectal surgery is a rare, mostly self-limiting, postoperative complication that could lead to a life-threatening condition. Therefore, prompt management is required. This study aimed to evaluate the efficacy and safety of endoscopic clipping for acute anastomotic bleeding after colorectal surgery.
Methods
We retrospectively reviewed the data of patients pathologically diagnosed with colorectal cancer at National Cancer Center, Korea from January 2018 to November 2020, which presented with anastomotic bleeding within the first postoperative week and were endoscopically managed with clips.
Results
Nine patients had anastomotic bleeding, underwent endoscopic management, and, therefore, were included in this study. All patients underwent laparoscopic (low/ultralow) anterior resection with mechanical double-stapled anastomosis. Anastomotic bleeding was successfully managed through a colonoscopy with clips on the first trial in all patients. Hypovolemic shock occurred in one patient, following anastomotic breakdown.
Conclusion
Endoscopic clipping seems to be an effective and safe treatment for anastomotic bleeding with minimal physiologic stress, easy accessibility, and scarce postoperative complications. However, a surgical backup should always be considered for massive bleeding.

Citations

Citations to this article as recorded by

Post-Surgical Imaging Assessment in Rectal Cancer: Normal Findings and Complications
Federica De Muzio, Roberta Fusco, Carmen Cutolo, Giuliana Giacobbe, Federico Bruno, Pierpaolo Palumbo, Ginevra Danti, Giulia Grazzini, Federica Flammia, Alessandra Borgheresi, Andrea Agostini, Francesca Grassi, Andrea Giovagnoni, Vittorio Miele, Antonio B
Journal of Clinical Medicine.2023; 12(4): 1489. CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef

Case Report

Benign proctology,Complication,Biomarker & risk factor

Recurrent bleeding after posthemorrhoidectomy caused by factor V deficiency: a case report and review of the literature: Jun Seong Chung, Han Deok Kwak, Jae Kyun Ju; Ann Coloproctol. 2022;38(6):449-452. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2021.00185.0026

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Abstract PDF

Congenital factor V (FV) deficiency is a rare hemorrhagic disorder that can cause excessive bleeding during and after surgery in the affected patient. This report is the case of a patient who had FV deficiency with recurrent posthemorrhoidectomy bleeding treated with the hemostatic procedure and fresh frozen plasma (FFP) transfusions. A 45-year-old male patient had previously undergone hemorrhoidectomy for multiple hemorrhoids at a local hospital. Hemorrhoidectomy was successful; however, he was transferred to our hospital for evaluation of the origin of the recurrent posthemorrhoidectomy bleeding and underwent a hemostatic procedure. This bleeding was treated with coagulation using electrocautery, multiple sutures, and FFP transfusion (1,600 mL/day) for 7 consecutive days. The patient’s plasma FV activity was 23%. Early detection of clotting factor deficiency in patients with hemorrhagic events after surgical treatments may prevent unnecessary procedures such as reoperations and minimize the cost of replacement therapy such as large-volume FFP transfusion.

Citations

Citations to this article as recorded by

Rare Inherited Coagulation Deficiencies: A Single-center Study
Özlem Terzi, Sadik Sami Hatipoğlu
Journal of Pediatric Hematology/Oncology.2025; 47(2): e90. CrossRef
Plasma/tranexamic-acid/vitamin-k

Reactions Weekly.2023; 1954(1): 383. CrossRef

Original Article

Benign proctology,Complication,Biomarker & risk factor

Frequency and risk factors of severe postoperative bleeding after proctological surgery: a retrospective case-control study: Sarah Taieb, Patrick Atienza, Jean-David Zeitoun, Milad Taouk, Josée Bourguignon, Christian Thomas, Nabila Rabahi, Saliha Dahlouk, Anne-Carole Lesage, David Lobo, Isabelle Etienney; Ann Coloproctol. 2022;38(5):370-375. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2021.00122.0017

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Abstract PDF

Purpose
The aim of this study was to assess frequency and risk factors of severe bleeding after proctological surgery requiring hemostatic surgery observed after publication of the French guidelines for anticoagulant and platelet-inhibitor treatment.
Methods
All patients who underwent proctological surgery between January 2012 and March 2017 in a referral center were included. Delay, severity of bleeding, and need for blood transfusion were recorded. Patients with severe postoperative bleeding were matched to controls at a 2:1 ratio adjusted on the operator, and the type of surgery.
Results
Among the 8,890 operated patients, 65 (0.7%) needed a postoperative hemostatic procedure in an operating room. The risk of a hemostatic surgery was significantly increased after hemorrhoidal surgery compared with other procedures (1.9% vs. 0.5%, P<10^–4) and was most frequent after Milligan-Morgan hemorrhoidectomy (2.5%). Mean bleeding time was 6.2 days and no bleeding occurred after day 15. Blood transfusion rate was 0.1%. Treatment with anticoagulants and platelet inhibitors were managed according to recommendations and did not increase the severity of bleeding. The risk of severe bleeding was significantly lower in active smokers vs. non-smokers in univariate (16.9% vs. 36.2%, P=0.007) and multivariate (odds ratio, 0.31; 95% confidence interval, 0.14–0.65) analysis whereas sex, age, and body mass were not significantly associated with bleeding.
Conclusion
Severe postoperative bleeding occurs in 0.7% of patients, but varies with type of procedure and is not affected by anticoagulant or antiplatelet treatment. These treatments given in accordance with the new guidelines do not increase the severity of postoperative bleeding.

Citations

Citations to this article as recorded by

Efficacy of Endoscopic Evaluation and Hemostatic Intervention for Post-hemorrhoidectomy Bleeding
Katsuhisa Ohashi, Katsuhide Ohashi, Akinori Sasaki, Kazuyoshi Ota, Kazutomo Kitagawa
Journal of the Anus, Rectum and Colon.2025; 9(1): 162. CrossRef
Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients
Inese Fišere, Valērija Groma, Šimons Svirskis, Estere Strautmane, Andris Gardovskis
Journal of Clinical Medicine.2023; 12(15): 5119. CrossRef
Sclerobanding in the treatment of second and third degree hemorrhoidal disease in high risk patients on antiplatelet/anticoagulant therapy without suspension: a pilot study
Francesco Pata, Luigi M. Bracchitta, Bruno Nardo, Gaetano Gallo, Giancarlo D’Ambrosio, Salvatore Bracchitta
Frontiers in Surgery.2023;[Epub] CrossRef
Principles of minimize bleeding and the transfusion of blood and its components in operated patients – surgical aspects
Tomasz Banasiewicz, Waldemar Machała, Maciej Borejsza Wysocki, Maciej Lesiak, Sebastian Krych, Małgorzata Lange, Piotr Hogendorf, Adam Durczyński, Jarosław Cwaliński, Tomasz Bartkowiak, Adam Dziki, Wojciech Kielan, Stanisław Kłęk, Łukasz Krokowicz, Krzysz
Polish Journal of Surgery.2023; 95(5): 14. CrossRef

Case Report

Major Pelvic Bleeding Following a Stapled Transanal Rectal Resection: Use of Laparoscopy as a Diagnostic Tool: Giovanni Domenico Tebala, Abdul Qayyum Khan, Sean Keane; Ann Coloproctol. 2016;32(5):195-198. Published online October 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.5.195

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Abstract PDF

Stapled transanal rectal resection (STARR) and stapled hemorrhoidopexy (SH) are well-established techniques for treating rectal prolapse and obstructed defecation syndrome (ODS). Occasionally, they can be associated with severe complications. We describe the case of a 59-year-old woman who underwent STARR for ODS and developed a postoperative pelvic hemorrhage. A computed tomography (CT) scan revealed a vast pelvic, retroperitoneal hematoma and free gas in the abdomen. Laparoscopy ruled out any bowel lesions, but identified a hematoma of the pelvis. Flexible sigmoidoscopy showed a small leakage of the rectal suture. The patient was treated conservatively and recovered completely. Surgeons performing STARR and SH must be aware of the risk of this rare, but severe, complication. If the patient is not progressing after a STARR or SH, a CT scan can be indicated to rule out intra-abdominal and pelvic hemorrhage. Laparoscopy is a diagnostic tool and should be associated with intraluminal exploration with flexible sigmoidoscopy.

Citations

Citations to this article as recorded by

Severe Postoperative Bleeding After Stapled Hemorrhoidopexy: Incidence and Causes
Huabing Chen, Zaili Tang, Zhousong Wu, Renjie Shi
Indian Journal of Surgery.2021; 83(5): 1223. CrossRef
Update on obstructed defecation syndrome
Reem A. Alharbi
Saudi Surgical Journal.2021; 9(1): 1. CrossRef
Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm
Georgi Popivanov, Piergiorgio Fedeli, Roberto Cirocchi, Massimo Lancia, Domenico Mascagni, Michela Giustozzi, Ivan Teodosiev, Kirien Kjossev, Marina Konaktchieva
Medicina.2020; 56(6): 269. CrossRef
Common operation, uncommon complication. Bleeding from superior haemorrhoidal artery after minimally invasive procedure for hemorrhoids – a case report
Janavikula Sankaran Rajkumar, Aluru Jayakrishna Reddy, Ravikumar Radhakrishnan, Anirudh Rajkumar, Syed Akbar, Dharmendra Kollapalayam Raman
Journal of Coloproctology.2019; 39(01): 070. CrossRef
A Rare Complication of Stapled Hemorrhoidopexy: Giant Pelvic Hematoma Treated with Super-Selective Percutaneous Angioembolization
Francesco Ferrara, Paolo Rigamonti, Giovanni Damiani, Maurizio Cariati, Marco Stella
Annals of Colorectal Research.2018;[Epub] CrossRef

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