Polipektomi sonrası kanamada endoskopik bant ligasyonunun kullanımı

Abstract

A 61-year-old woman underwent colonoscopy to investigate lower gastrointestinal bleeding. A pedunculated polyp with a long stalk was identified in the sigmoid colon, and snare polypectomy was performed. Postpolypectomy arterial bleeding occurred after the resection, and the bleeding was stopped with immediate epinephrine and sclerosing agent injection. However, rectal bleeding started again three hours after polypectomy. In the repeat colonoscopic investigation, the site of the bleeding was confirmed at the stalk of the removed polyp. Endoscopic band ligation of the stalk was performed using a gastroscope and ligator instrument, and bleeding from the stalk was successfully controlled. Key words: Band ligation, polypectomy, hemorrhageAlt gastrointestinal kanama flüphesiyle kolonoskopi yap›lan 61 yafl›nda kad›n hastada sigmoid kolonda uzun sapl› bir polip saptand›. Polipektomi yap›lan hastada ifllem sonras› ciddi arteriyel kanama olmas› üzerine ifllem bölgesine acilen epinefrin ve sklerozan ajan uygulanarak kanama kontrolü sa¤land›. 3 saat sonra hastan›n rektal kanamas›n›n tekrarlamas› üzerine kontrol kolonoskopide polip sap›ndan kanaman›n devam etti¤i gözlendi. Bunun üzerine polip sap›na gastroskop ile endoskopik bant ligasyon uyguland›. Bu uygulama ile kanama baflar›l› bir flekilde durdurulabildi. Anahtar kelimeler: Bant ligasyon, polipektomi, hemoraji INTRODUCTIONEndoscopic polypectomy is considered the standard of care for the treatment of colorectal polyps (1). The two most important complications of polypectomy are perforation and bleeding. Hemorrhage has been reported to occur after 1-6% of polypectomies, with clinically significant bleeding in only some 1% of the cases (1-4). In general, bleeding occurs during the transection of the polyp stalk. Delayed bleeding can occur after a few hours or even after a few days in 2% of the patients. Less than 50% occurs immediately after the procedure (1-3).Bleeding prophylaxis can be attempted using several techniques, such as application of hemoclips, endoloops or injection of sclerosing solutions (5-9). CASE REPORTA 61-year-old woman underwent colonoscopy to investigate the source of lower gastrointestinal bleeding. The examination was performed with the patient under conscious sedation with meperidine 25 mg and midazolam 2 mg given intravenously. During the procedure, a pedunculated polyp with a long stalk was identified in the sigmoid colon, and snare polypectomy was applied (Figure 1). Postpolypectomy arterial bleeding occurred immediately after the resection ( Figure 2). The bleeding was stopped with immediate epinephrine and sclerosing agent injection. However, rectal bleeding started again three hours after polypectomy with hemodynamically significant acute hematochezia and an abrupt decrease in hematocrit level from 39% to 24%. Prothrombin time was 50 seconds. She had a history of coumadin use due to coronary heart disease. The patient was transfused with 6 units of packed red cells and 9 units of fresh frozen plasma. Urgent colonoscopy revealed an arterial ...