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KMID : 0356720050210060390
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Journal of the Korean Society of Coloproctology
2005 Volume.21 No. 6 p.390 ~ p.395
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Step-by-step Management and Treatment Outcome of Bleeding Control for Anastomosis Site after Low Anterior Resection with Double Stapling Technique
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KIm Hyuk-Moon
Shin Eung-Jin
Song Ok-Pyung
Kim Jae-Joon
Jang Young-Suk
Park Nae-Kyung
Baek Moo-Joon
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Abstract
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Purpose: This study reviews our experience with a step- by-step management approach of increasing aggressiveness and evaluates the treatment outcome for intraluminal hemorrhage.
Methods: The study group was comprised of patients who had experienced intraluminal hemorrhage after a low anterior resection with the double stapling technique from 1999 to 2003. The choice of management was selected according to our step-by-step management protocol, and the outcomes were evaluated for each step, lincluding mortality and complications.
Nine patients (6 males and 3 females, mean age 55 years) were identified, the mean volume of packed RBC transfusion was 2 pints, and the mean distance of the anastomotic site from the anal verge was 6 cm. The median stapler size was 31 mm. The first step was cold saline irrigation and drainage; four of 9 patients were controlled. The second step was retention enema with topical hemostatics; one of remaining 5 patients stopped bleeding. The third step was colonoscopic hypertonic saline injection around the bleeding site with direct colonoscopic electrocauterization, two of remaining 4 patients were controlled. The last step was suturing the bleeding site through the anus, the remaining 2 patients stopped bleeding. One of the 9 patients developed leakage from the anastomotic site after the last step management, three of the 9 patients had long standing ileus, and one of the 9 patients developed acute renal failure after a massive transfusion. There were no postoperative deaths.
Conclusions: It is safer and easier to control bleeding with step-by-step management system of increasing aggressiveness. J Korean Soc Coloproctol 2005;21:390-395
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KEYWORD
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Rectal cancer, Low anterior resection, Hemorrhage, Stapling
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