868 The management of acute lower gastrointestinal bleeding using a Sengstaken-Blakemore tube

Abstract Introduction Acute lower gastrointestinal haemorrhage can potentially be life-threatening. We present a case of a massive rectal bleed which was managed successfully with a balloon tamponade device designed for upper gastrointestinal haemorrhage. Presentation of case A 75-year-old gentleman, with a history of human immunodeficiency virus and cirrhosis with portal hypertension, presented with bright red rectal bleeding. Investigations showed a low haemoglobin level (74 g/L) and deranged clotting. Oesophago-gastro-duodenoscopy demonstrated no fresh or altered blood. Flexible sigmoidoscopy revealed active bleeding from a varix within the anterior rectal wall 4 cm from the anal verge. Efforts to stop the bleeding, including endoscopic clips, adrenaline injection and rectal packing, were unsuccessful and the patient became haemodynamically unstable. A Sengstaken-Blakemore tube was inserted per rectum and the gastric balloon was inflated to tamponade the lower rectum. The oesophageal balloon was then inflated to hold the gastric balloon firmly in place. A computed tomography angiogram demonstrated no evidence of haemorrhage with balloon tamponade. After 36 h, the balloon was removed with no further episodes of bleeding. Discussion The application of a balloon tamponade device should be considered in the management algorithm for acute lower gastrointestinal bleed. Advantages include its rapid insertion, immediate results and ability to measure further bleeding after the catheter has been placed. Conclusions Sengstaken-Blakemore tube per rectum may effectively control massive low rectal bleeding when alternative methods have been unsuccessful.

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Transanal advancement of the anterior rectal wall for vaginal fistulas involving the lower rectum

Diseases of the Colon & Rectum ◽

10.1007/bf02587089 ◽

1980 ◽

Vol 23 (4) ◽

pp. 236-241 ◽

Cited By ~ 30

Author(s):

John R. Hilsabeck

Keyword(s):

Rectal Wall ◽

Anterior Rectal Wall ◽

Lower Rectum

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Successful surgical treatment of intractable post-radiation rectal bleeding

Surgical Techniques Development ◽

10.4081/std.2021.9125 ◽

2022 ◽

Vol 10 (1) ◽

Author(s):

Rezvan Mirzaei ◽

Bahar Mahjoubi ◽

Jalil Shoa ◽

Roozbeh Cheraghali ◽

Zahra Omrani

Keyword(s):

Surgical Treatment ◽

Rectal Bleeding ◽

Rectal Wall ◽

Anal Verge ◽

Metastatic Breast ◽

Main Role ◽

Anal Region ◽

Diverting Stoma ◽

Radiation Colitis ◽

Post Radiation

Patients will typically present symptoms of chronic post-radiation colitis and proctitis 8-12 months after finishing their treatment. Endoscopic methods play the main role the treatment of bleeding caused by post-radiation colitis and proctitis. Surgical treatment is required for remained approximately 10% of patients. Here we present a 64 year old female with metastatic breast cancer, who was referred to us for intractable rectal bleeding. Total colonoscopy and rigid rectosigmoidoscopy revealed proctitis, rectal and sigmoidal telangiectasis, multiple necrotic ulcers between 15 to 30 cm from the anal verge, and also huge ishemic ulcer with patchy necrotic areas about 10 cm from the anal verge. This abnormal irradiated part was resected and then mucosectomy of the remnant rectum, both transabdominally and transanally was done. We performed pull-through technique of normal proximal colon to anal region through the remnant rectal wall and finally did coloanal anastomosis. Diverting stoma was not made because of anastomosis in anal region. With this technique we can achieve benefits such as avoidance of harsh dissection in a frozen pelvis and its consequences, we can avoid intra-abdominal anastomosis, there is no need to a diverting stoma and, most important of all, definite bleeding control.

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Endoscopic Therapy in the Management of Patients With Severe Rectal Bleeding Following Transrectal Ultrasound-Guided Prostate Biopsy: A Case-Based Systematic Review

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211013206 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110132

Author(s):

Adnan Malik ◽

Rizwan Ishtiaq ◽

Muhammad Hassan Naeem Goraya ◽

Faisal Inayat ◽

Vinaya V. Gaduputi

Keyword(s):

Rectal Bleeding ◽

Prostate Biopsy ◽

Endoscopic Therapy ◽

Rectal Wall ◽

Transrectal Ultrasound ◽

Uneventful Recovery ◽

Anterior Rectal Wall ◽

Ultrasound Guided ◽

Endoscopic Techniques ◽

Life Threatening

Rectal bleeding is a known complication of transrectal ultrasound-guided prostate biopsy. It is usually mild and resolves spontaneously. However, massive life-threatening hemorrhage can also rarely occur in this setting, potentially presenting a therapeutic conundrum. We hereby delineate the case of a patient who experienced severe intermittent lower gastrointestinal bleeding following a transrectal ultrasound-guided prostate biopsy. Traditional tamponade methods failed to control the hemorrhage. Subsequently, an urgent flexible sigmoidoscopy revealed an anterior rectal wall prominence with biopsy punctures as the possible source of bleeding. Endoclip was successfully applied at the bleeding site, achieving permanent hemostasis. The patient had an uneventful recovery and was discharged from the hospital. While the use of endoclipping has been widely reported in gastrointestinal endoscopy, its application remains exceedingly rare in this group of patients. To our knowledge, this case represents only the third report of endoclipping alone to treat massive rectal bleeding follwing a prostate biopsy procedure. In addition, we systematically review published medical literature to evaluate endoscopic techniques aimed at managing this important complication. This article illustrates that endoscopic therapy may present an efficient, noninvasive method to deal with severe post-biopsy rectal hemorrhage. Therefore, prompt consultation with the gastroenterology service should be advocated.

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Retrospective study of the functional and oncological outcomes of conformal sphincter preservation operation in the treatment of very low rectal cancer

Techniques in Coloproctology ◽

10.1007/s10151-020-02229-2 ◽

2020 ◽

Vol 24 (10) ◽

pp. 1025-1034 ◽

Cited By ~ 1

Author(s):

G. Sun ◽

Z. Lou ◽

H. Zhang ◽

G. Y. Yu ◽

K. Zheng ◽

...

Keyword(s):

Rectal Cancer ◽

Rectal Wall ◽

Anal Verge ◽

Disease Free Survival ◽

Sphincter Preservation ◽

Low Rectal Cancer ◽

Anal Function ◽

Oncological Outcomes ◽

Rectal Cancers ◽

Very Low Rectal Cancer

Abstract Background Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4–5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. Methods Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. Results A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3–4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3–0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12–45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. Conclusions For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.

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Radiobiological Evaluation of Dosimetric Plans for Stereotactic Radiotherapy for Prostate Cancer According to Fractionation Regimen

Journal of radiology and nuclear medicine ◽

10.20862/0042-4676-2019-100-5-263-269 ◽

2019 ◽

Vol 100 (5) ◽

pp. 263-269

Author(s):

E. S. Sukhikh ◽

I. N. Sheyno ◽

L. G. Sukhikh ◽

A. V. Taletskiy ◽

A. V. Vertinskiy ◽

...

Keyword(s):

Radiation Therapy ◽

Total Dose ◽

Rectal Wall ◽

Tumor Control ◽

Anterior Rectal Wall ◽

Tumor Control Probability ◽

Equivalent Uniform Dose ◽

Dose Volume Histograms ◽

Dose Volume ◽

Fractionation Regimen

Objective. To determine the most effective irradiation regimen (total dose and dose per fraction) for hypofractionated treatment for prostate carcinomas according the TCP/NTCP radiobiological criteria.Material and methods. Using the tomographic information of five patients with low-risk prostate adenocarcinoma as an example, the authors devised dosimetric radiation therapy plans using the volumetric modulated arc therapy (VMAT) procedure. They considered the range of total doses of 33.5 to 38 Gy administered in 4 and 5 fractions. Based on the equivalent uniform dose concept proposed by A. Niemierko and on the computed differential dose volume histograms, the investigators modeled local tumor control probability (TCP) values, by taking into account the uncertainties of main radiobiological parameters, and estimated normal tissue complication probabilities (NTCP) for the anterior rectal wall as the organ most at risk of irradiation. An effective dosimetric plan was selected according to the UTCP criterion and the probability of complication-free tumor control, i.e. TCP (1 – NTCP).Results. The results of modeling the UTCP criterion show that with a higher total dose, the TCP value increases and so does the NTCP value, therefore the optimal radiation therapy plans are to irradiate with a total dose of 34 Gy over 4 fractions or with a dose of 36–37 Gy over 5 fractions. The difference between the fractionation regimens is that the UTCP value is achieved with a higher TCP value over 4 fractions and with a lower load on the rectal wall over 5 fractions.Conclusion. The choice of a specific fractionation regimen should be determined from the calculated values of differential dose volume histograms for each patient, as well as from radiobiological criteria, such as TCP, NTCP and UTCP.

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Primary prostatic extragastrointestinal stromal tumor: a case report and literature review

Journal of International Medical Research ◽

10.1177/0300060518791677 ◽

2018 ◽

Vol 46 (10) ◽

pp. 4343-4349 ◽

Cited By ~ 3

Author(s):

Yong-hao You ◽

Yi Zhang

Keyword(s):

Literature Review ◽

Rectal Wall ◽

Smooth Muscle Actin ◽

Treatment Method ◽

Stromal Tumor ◽

Anterior Rectal Wall ◽

Muscle Actin ◽

Pelvic Tumor ◽

Extragastrointestinal Stromal Tumor ◽

Spindle Cells

Objective This study was performed to discuss the characteristics, diagnosis, and treatment of primary prostatic extragastrointestinal stromal tumor (EGIST). Methods The case history data of a patient with an EGIST were analyzed and discussed with a literature review. Results The patient was diagnosed with a pelvic tumor, possibly malignant. We ascertained the diagnosis by exploratory surgery and pathological biopsy. The tumor was present in the prostate and infiltrated and pressed against the anterior rectal wall. Pathological biopsy showed that the tumor comprised spindle cells, which were also present at the junction of the tumor and prostate tissue. Immunohistochemically, the tumor cells were positive for CD117, DOG-1, CD34, and smooth muscle actin and negative for S100 and desmin; Ki-67LI was about 10%. These results support the diagnosis of primary prostatic EGIST. Conclusion The rarity and nonspecific clinical manifestation of prostatic EGIST facilitate misdiagnosis. Diagnosis mainly depends on imaging examination and characteristic histopathological and immunohistochemical features, and GIST must be excluded. Surgery is the main treatment method, and imatinib is suggested for unresectable and malignant EGISTs.

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

Medicina ◽

10.3390/medicina56060269 ◽

2020 ◽

Vol 56 (6) ◽

pp. 269 ◽

Cited By ~ 1

Author(s):

Georgi Popivanov ◽

Piergiorgio Fedeli ◽

Roberto Cirocchi ◽

Massimo Lancia ◽

Domenico Mascagni ◽

...

Keyword(s):

Rectal Bleeding ◽

Rectal Wall ◽

Original Data ◽

Operative Management ◽

Stapled Hemorrhoidopexy ◽

Current Evidence ◽

Transanal Surgery ◽

Hartmann Procedure ◽

Ct Guided ◽

Abdominal Bleeding

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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