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

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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Non-operative management of intra-abdominal bleeding and retroperitoneal hematoma after stapling procedure for prolapsed hemorrhoids

Chirurgia ◽

10.23736/s0394-9508.18.04935-5 ◽

2020 ◽

Vol 32 (6) ◽

Author(s):

Lorenzo Ripamonti ◽

Matteo Maternini ◽

Angelo Guttadauro

Keyword(s):

Operative Management ◽

Retroperitoneal Hematoma ◽

Abdominal Bleeding ◽

Non Operative Management

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68Ga-DOTATOC-PET/CT–guided resection of a primary intraosseous meningioma: technical note

Neurosurgical FOCUS ◽

10.3171/2020.10.focus20771 ◽

2021 ◽

Vol 50 (1) ◽

pp. E6

Author(s):

Gerardo Y. Guinto-Nishimura ◽

Juan L. Gómez-Amador ◽

Nora Kerik-Rotenberg ◽

Rodrigo Uribe-Pacheco ◽

Marcos V. Sangrador-Deitos ◽

...

Keyword(s):

Somatostatin Receptors ◽

Technical Note ◽

Complete Resection ◽

Current Evidence ◽

Pathology Report ◽

Ct Guided ◽

Tumor Margins ◽

Valuable Adjunct ◽

Pet Ct ◽

Intraosseous Meningioma

Primary intraosseous meningiomas (PIMs) are rare tumors that present with a variable radiological appearance and a clinical behavior that is considerably different from that of intracranial meningiomas. Treatment of PIMs consists of complete resection, which may be difficult to achieve due to the lack of clear tumor margins on conventional imaging studies. PET/CT using 68Ga-DOTA–conjugated peptides has been used for the diagnosis and treatment planning of different types of meningiomas due to these tracers’ affinity to somatostatin receptors, which are found in most meningiomas. However, this imaging modality’s use as an intraoperative adjunct has not been reported for PIMs. In this technical note, the authors describe a [68Ga-DOTA0-Tyr3]octreotide (68Ga-DOTATOC)-PET/CT–guided resection of a PIM. In this case, the area of increased uptake in the 68Ga-DOTATOC-PET/CT study extended well beyond the tumor margins identified on MRI. The patient’s pathology report confirmed the presence of tumor cells within peripheral bone, which macroscopically appeared normal. The authors propose 68Ga-DOTATOC-PET/CT as a valuable adjunct in the surgical management of PIMs and offer a reasonable justification for its use based on current evidence. Its use for intraoperative image guidance may aid neurosurgeons in achieving a complete resection, thus minimizing the risk of recurrence of this complex pathological entity.

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Adjuvant and Neoadjuvant Management of Colorectal Cancer

10.2310/gastro.2270 ◽

2020 ◽

Author(s):

Christina E Bailey ◽

Eduardo Vilar ◽

Y. Nancy You

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Neoadjuvant Therapy ◽

Significant Proportion ◽

Operative Management ◽

The United States ◽

Current Evidence ◽

Recurrence Rates ◽

Curative Intent ◽

Colon And Rectal Cancer

Colorectal cancer (CRC) is the third most common and lethal cancer in men and women in the United States. At presentation, a significant proportion of patients with CRC are able to undergo resection with curative intent, but up to 50% of these patients will develop recurrent disease. Fortunately, recurrence rates for both colon and rectal cancer have improved with the introduction of multimodality therapies, which include chemotherapy, chemoradiation therapy, and radiation therapy. These therapies are adjuncts to surgery and can be administered before (i.e. neoadjuvant) or after (i.e. adjuvant) surgery. This review summarizes the current evidence for the use of adjuvant and neoadjuvant therapies in colon and rectal cancer. This review contains 2 figures, 7 tables, and 77 references. Keywords: Colon cancer, rectal cancer, neoadjuvant therapy, adjuvant therapy, total neoadjuvant therapy, induction chemotherapy in rectal cancer, chemoradiation, organ preservation, non-operative management

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

British Journal of Surgery ◽

10.1093/bjs/znab259.331 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Iskandarani ◽

M Fadel ◽

P Boshier ◽

A M Howell ◽

P Tekkis ◽

...

Keyword(s):

Rectal Bleeding ◽

Rectal Wall ◽

Anal Verge ◽

Gastrointestinal Haemorrhage ◽

Alternative Methods ◽

Anterior Rectal Wall ◽

Gastric Balloon ◽

Lower Rectum ◽

Balloon Tamponade ◽

Endoscopic Clips

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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Pure Primary Ovarian Squamous Cell Carcinoma Perforating the Rectum

Case Reports in Obstetrics and Gynecology ◽

10.1155/2017/9793086 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Kazuya Mimura ◽

Aiko Okada ◽

Naotsugu Haraguchi ◽

Kenjiro Sawada ◽

Takuji Tomimatsu ◽

...

Keyword(s):

Ovarian Cancer ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Rectal Bleeding ◽

Rectal Wall ◽

En Bloc Resection ◽

Common Symptom ◽

Rectal Perforation ◽

En Bloc

Rectal perforation is uncommon in ovarian cancer, even in advanced stages. Pure primary ovarian squamous cell carcinoma is a very rare subtype of ovarian cancer and has not been reported to cause rectal perforation. A 50-year-old woman presented with rectal bleeding. Rectosigmoidoscopy suggested perforation of a pelvic tumor into the rectum. Abdominopelvic magnetic resonance imaging revealed a 9 cm heterogeneous mass in the pouch of Douglas. We performed complete cytoreduction, including an en-bloc resection of the tumor and rectosigmoid colon. Histopathology showed squamous cell carcinoma of the left ovary penetrating the rectal wall. A common symptom of rectal bleeding was caused by a very rare entity of ovarian cancer penetrating the rectal wall, but thorough evaluation led to its accurate diagnosis and appropriate treatment.

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Non-operative management of intra-abdominal bleeding due to blunt trauma in children: The risk of missed associated intestinal injuries

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(99)90294-4 ◽

1999 ◽

Vol 34 (1) ◽

pp. 230-231

Author(s):

P Puri

Keyword(s):

Blunt Trauma ◽

Operative Management ◽

Abdominal Bleeding ◽

Non Operative Management

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Nodding Syndrome: A Scoping Review

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6040211 ◽

2021 ◽

Vol 6 (4) ◽

pp. 211

Author(s):

Gasim Omer Elkhalifa Abd-Elfarag ◽

Arthur Wouter Dante Edridge ◽

René Spijker ◽

Mohamed Boy Sebit ◽

Michaël B. van Hensbroek

Keyword(s):

Scoping Review ◽

Treatment Options ◽

Original Data ◽

Current Evidence ◽

Future Research ◽

African Countries ◽

Comprehensive Overview ◽

Severe Condition ◽

Nodding Syndrome ◽

Sub Saharan

Nodding syndrome (NS) is a debilitating yet often neglected neurological disease affecting thousands of children in several sub-Saharan African countries. The cause of NS remains unknown, and effective treatment options are lacking. Moreover, knowledge regarding NS is scarce and is based on a limited number of publications, with no comprehensive overview published to date. Therefore, the aim of this scoping review was to summarise the current evidence and identify existing knowledge gaps in order to help clinicians, scientists, and policymakers develop guidelines for prioritising this severe condition. We searched the Medline (Ovid), Embase (Ovid), Scopus, and Global Health Library databases in accordance with the PRISMA extension for scoping review guidance and in accordance with the Joanna Briggs Institute guidelines and methodology for a scoping review, using keywords describing NS. We then extracted and presented the original data regarding the epidemiology, aetiology, pathophysiology, clinical features, diagnosis, management, and outcomes of NS, as well as community perceptions and the psychosocial and economic impact of NS. Out of 1470 identified articles, a total of 69 were included in this scoping review. Major gaps exist in understanding the aetiology and pathogenesis of NS. Future research is urgently needed not only to address these gaps, but also to study the treatment options, epidemiology, and psychosocial and economic impacts of NS. Innovative interventions and rehabilitation programmes designed to address the psychosocial and economic burdens associated with NS are also urgently needed.

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Assessment and management of adult ankle fractures: understanding the evidence

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0445 ◽

2021 ◽

pp. 1-9

Author(s):

Grace Yip ◽

Daniel Hay ◽

Tom Stringfellow ◽

Aashish Ahluwalia ◽

Raju Ahluwalia

Keyword(s):

Best Practice ◽

Screw Fixation ◽

Operative Management ◽

Ankle Fractures ◽

Current Evidence ◽

Ankle Stability ◽

Posterior Malleolus ◽

Injury Assessment ◽

Non Operative Management ◽

Tomography Scan

Ankle fractures are a common injury. Assessment should include looking at the mechanism of injury, comorbidities, associated injuries, soft tissue status and neurovascular status. Emergent reduction is required for clinically deformed ankles. Investigations should include plain radiographs and a computed tomography scan for more complex injuries or those with posterior malleolus involvement. An assessment of ankle stability determines treatment, taking into account comorbidities and preoperative mobility which need special consideration. Non-operative management includes splint or cast, allowing for early weightbearing when the ankle is stable. Operative management includes open reduction and internal fixation, intramedullary nailing (of the fibula and hindfoot) and external fixation. Syndemosis stabilisation includes suture button or screw fixation. The aim of treatment is to restore ankle stability and this article explores the current evidence in best practice.

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