Antonio M. Lacy, Maria Fernández
Hospital Clínic, Barcelona, Spain
A 64 years old male patient with history of tricuspid biological prosthesis and atrial flutter treated with a pacemaker plus warfarin, was diagnosed of colorectal cancer after population screening.
By colonoscopy the lesion was a 26cm from the anal verge and CT-Scan ruled out metastasis, so he underwent a sigmoidectomy by laparoscopy, a mechanical end to end anastomosis was performed without any intraoperative events. At the immediate postoperative period the patient presented rectal bleeding, dropping of hemoglobin and haemodynamic instability.
At the presence of intraluminal bleeding a colonoscopy was performed, it found hemorrhage from the stapler line, a couple of clips were placed achieving partial control of the situation. The next step for the treatment of this complication is surgery.
In this case, the surgeon chose the transanal approach (feasible because of the height of the anastomosis). As you can see in the video the transanal device was placed identifying persistence of the bleeding, the clips were removed, a couple of endolumenal stitches were made and reinforced with a homeostatic sponge.
This strategy was successful, with a quick control of the hemorrhage, giving the patient a minimally invasive treatment and small surgical aggression that resulted in preservation of the anastomosis.