Retroperitoneales H�matom mit sekund�rer Nahtinsuffizienz

Meyer, P.; Stieger, Roland

doi:10.1007/s00104-004-0916-7

Cited by 15 publications

(11 citation statements)

References 7 publications

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“…In the latter case, blood can spread into the mesorectal space towards the retroperitoneal plane and hypothetically can reach to the lower mediastinum as just described in a case report of rectal perforation after SH. 10 Reason of early postoperative bleeding is always a lack in closure of blood vessels mainly when the whole thickness of rectal wall filling the device is cut but not adequately squeezed by the stapling line, 11 while delayed bleeding may also be caused by a granuloma in 17% of cases 12 which may be surgically removed. In any case, the role of staple features has been widely discussed 1 in the “era” of PPH but currently after the developing of new staple devices this topic should be reconsidered in further comparison studies.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic approach in a case of retroperitoneal and mesorectal haematoma following STARR procedure

Cerullo

Cassini

Martellucci

et al. 2015

International Journal of Surgery Case Reports

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INTRODUCTIONStapled transanal rectal resection (STARR) is a widely accepted procedure for treatment of obstructed defecation syndrome.PRESENTATION OF CASEWe analyzed major bleeding following STARR and exposed our experience regarding its conservative management with particular attention about diagnostic and therapeutic aspects.DISCUSSIONA case by case discussion should be carried out and treatments should be driven by the features and the progression of the haematoma with regards to size, inflammatory signs or severe rectal obstruction.CONCLUSIONIf a second surgical time and exploration is considered, laparoscopy should be an effective choice while laparotomy, stoma or rectal resection should be considered in those cases with strong suspicious of peritonitis and pelvic abscess.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic approach in a case of retroperitoneal and mesorectal haematoma following STARR procedure

Cerullo

Cassini

Martellucci

et al. 2015

International Journal of Surgery Case Reports

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“…Seven studies were excluded based on reasons listed in Table 1 [12][13][14][15][16][17][18]. Cumulatively, 17 articles (15 case reports and two case series) were considered relevant, and 38 patients were included ( Figure 1, Seven papers reported perirectal hematoma [3,17,18,[20][21][22][23][24][25][26][27]. In seven articles, intraabdominal bleeding was described [28][29][30][31][32][33][34], two reported retroperitoneal hematoma [19,25].…”

Section: Resultsmentioning

confidence: 99%

“…The perirectal hematoma after SH is first described in 2004 by Meyer et al in a 52-year-old patient with grade III hemorrhoids [20]. On the first postoperative day, their patient manifests with symptoms of bleeding, and sudden anemia (8 g/L Hb, 24% Ht) without evident blood loss from the anus.…”

Section: Discussionmentioning

confidence: 97%

Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm

et al. 2020

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Background and Objectives: The present study aims to assess the effectiveness and current evidence of the treatment of perirectal bleeding after stapled haemorrhoidopexy. Materials and methods: A systematic literature review was performed that combined the published and the obtained original data after a search of PubMed, Web of Science, and SCOPUS. Results: The present systematic review includes 16 articles with 37 patients. Twelve papers report perirectal and six report intra-abdominal bleeding. Stapled hemorrhoidopexy (SH) was performed in 57% of cases (3 PPH 01 and 15 PPH 03), stapled transanal rectal resection (STARR) in 13%, and for 30% information was not available. The median age was 49 years (±11.43). The sign and symptoms of perirectal bleeding were abdominal pain (43%), pelvic discomfort without rectal bleeding (36%), urinary retention (14%), and external rectal bleeding (21%). The median time to bleeding was 1 day (±1.53 postoperative days), with median hemoglobin at diagnosis 8.8 ± 1.04 g/dL. Unstable hemodynamic was reported in 19%. Computed tomography scan (CT) was the first examination in 77%. Only two cases underwent the abdominal US, but subsequently, a CT scan was also conducted. Non-operative management was performed in 38% (n = 14) with selective arteriography and percutaneous angioembolization in two cases. A surgical treatment was performed in 23 cases—transabdominal surgery (3 colostomies, 1 Hartmann’ procedure, 1 low anterior resection of the rectum, 1 bilateral ligation of internal iliac artery and 1 ligation of vessels located at the rectal wall), transanal surgery (n = 13), a perineal incision in one, and CT-guided paracoccygeal drainage in one. Conclusions: Because of the rarity and lack of experience, no uniform tactic for the treatment of perirectal hematomas exists in the literature. We propose an algorithm similar to the approach in pelvic trauma, based on two main pillars—hemodynamic stability and the finding of contrast CT.

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“…However, a recent metanalysis documented that the rate of complications in "conventional" hemorrhoidectomies was higher than it was in the SH [7]. The European, German, and Italian STARR Registries rereported an incidence of bleeding from 2.9% to 5% after this procedure [8910]; however, very few cases of massive perirectal bleeding have been reported so far [11121314], and only one case after a STARR has been reported [14]. …”

Section: Discussionmentioning

confidence: 99%

Major Pelvic Bleeding Following a Stapled Transanal Rectal Resection: Use of Laparoscopy as a Diagnostic Tool

2016

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Stapled transanal rectal resection (STARR) and stapled hemorrhoidopexy (SH) are well-established techniques for treating rectal prolapse and obstructed defecation syndrome (ODS). Occasionally, they can be associated with severe complications. We describe the case of a 59-year-old woman who underwent STARR for ODS and developed a postoperative pelvic hemorrhage. A computed tomography (CT) scan revealed a vast pelvic, retroperitoneal hematoma and free gas in the abdomen. Laparoscopy ruled out any bowel lesions, but identified a hematoma of the pelvis. Flexible sigmoidoscopy showed a small leakage of the rectal suture. The patient was treated conservatively and recovered completely. Surgeons performing STARR and SH must be aware of the risk of this rare, but severe, complication. If the patient is not progressing after a STARR or SH, a CT scan can be indicated to rule out intra-abdominal and pelvic hemorrhage. Laparoscopy is a diagnostic tool and should be associated with intraluminal exploration with flexible sigmoidoscopy.

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Retroperitoneales H�matom mit sekund�rer Nahtinsuffizienz

Cited by 15 publications

References 7 publications

Laparoscopic approach in a case of retroperitoneal and mesorectal haematoma following STARR procedure

Laparoscopic approach in a case of retroperitoneal and mesorectal haematoma following STARR procedure

Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm

Major Pelvic Bleeding Following a Stapled Transanal Rectal Resection: Use of Laparoscopy as a Diagnostic Tool

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