Endoclipping treatment of life-threatening rectal bleeding after prostate biopsy

Abstract

Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound (TRUS)-guided multiple biopsy of the prostate, but is usually mild and stops spontaneously. We report what is believed to be the first case of life-threatening rectal bleeding following this procedure, which was successfully treated by endoscopic intervention through placement of three clips on the sites of bleeding. This case emphasizes endoscopic intervention associated with endoclipping as a safe and effective method to achieve hemostasis in massive rectal bleeding after prostate biopsy. Additionally, current data on the complications of the TRUS-guided multiple biopsy of the prostate and the options for treating fulminant rectal bleeding, a consequence of this procedure, are described.

Massive rectal bleeding after prostate biopsy controlled by endoclipping in a patient using ASA

“…[10][11][12][13][14][15][16] Most of them resolved with conservative therapy. Severe rectal bleeding is usually managed conservatively by the urologist with rectal tamponade.…”

“…Katsinelos and colleagues reported a case that was effectively treated with endoclipping, which is a common method used during endoscopy to treat gastrointestinal bleeding. 16 Endoscopic hemoclip placement can easily be achieved and is effective in immediate control of bleeding. Two clips that were deployed at the surrounding mucosa of the arterial bleeder were sufficient for occlusion in our case.…”

Severe Life Threatening Rectal Bleed After Prostate Biopsy Requiring Angiographic Therapy: A Case Report

“…Most of the hemorrhagic complications are minor and stop in a few days [8]. About seven cases of massive life threatening rectal bleeding following needle biopsy of the prostate have been reported in literature [6-13]. …”

“…The condom balloon tamponade was first reported by Murat Gonen et al and was preferred to the use of foley catheter due to a more effective pressure on both rectal wall and prostate [9]. Panagois Katsinelos reported a case that was effectively treated with endoclipping [13]. …”

Outcome analysis of ultrasound‐guided prostate biopsy procedure: a retrospective audit comparing associate consultant and nurse specialist in urology to determine the effectiveness and safety of a nurse‐led prostate biopsy clinic

“…Transrectal ultrasound of the prostate gland is a routine procedure carried out within the outpatient setting of most centres and generally tolerated well by patients. The rate of serious complications following prostate biopsy is relatively low, and few cases of life‐threatening rectal bleeding have been reported (Katsinelos et al , ; Ihimoyan et al , ). Some rectal bleeding is to be expected given the nature of the procedure but is usually mild.…”