Endoscopic management of anastomotic bleeding in the ileal pouch with staples removal and clipping

• Autor(a) principal: Wu,Xian-rui
• Data de Publicação: 2013
• Outros Autores: Lan,Nan, Shen,Bo
• Tipo de documento: Relatório
• Idioma: eng
• Título da fonte: Journal of Coloproctology (Rio de Janeiro. Online)
• Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2237-93632013000100039
• topic: Ileal pouch anal anastomosis; Bleeding; Pouchoscopy

OBJECTIVE: Postoperative pouch bleeding is a rare but detrimental complication following ileal pouch surgery. It is usually self-limited, however continuous bleeding requires intervention. There is limited published data on its management. DESIGN: Ileoscopy via stoma for loop ileostomy and pouchoscopy via anus for ileal pouch were performed under sedation for the purpose of diagnosis and management of postoperative bleeding. RESULTS: Ileoscopy demonstrated a large, long blood clot in the lumen of efferent limb, but no sign of active bleeding was identified. Pouchoscopy showed that lumen of pouch body as well as afferent limb was filled with maroon-colored liquid stool. Pouch and neo-terminal ileum mucosa was normal. Two dislodged staples at the anastomotic line with sharp tips towards the lumen were found, with activating bleeding at one site. The staples were removed by biopsy forceps, and active bleeding was successfully controlled by the deployment of one endoclip. CONCLUSIONS: We reported the first case that postoperative pouch bleeding, which was caused by dislodged staples, was successfully managed by endoscopic removal of the staples combined with clipping.