title: [Infrequent early complication of mechanical digestive anastomosis: bleeding. Personal experience].
abstract: BACKGROUND
  Bleeding from mechanical digestive anastomosis is an uncommon complication (0.9-3.2%) often self-limiting but potentially lethal if not evidenced intraoperatively or in the immediate postoperative.
  
  
  METHODS
  The Authors retrospectively report incidence of anastomotic bleeding after stapled anastomosis (11/163 = 6.7%) and analyse probable causes. In 6 of 11 patients (54%) intraoperative bleeding was stopped after manual reinforce of anastomosis (3/6) or stopped spontaneously (3/6). In 5 patients (45%), 1 with gastro-jejunal anastomosis, 2 with ileo-colonic anastomosis and 2 with colo-rectal anastomosis, they used endoscopy and endoscopic treatment in emergency.
  
  
  RESULTS
  All 5 patients were treated with endoscopic clerotherapy (NaCl 0.9% plus epinephrine 1:10000): in 4 (80%) the Authors obtained hemostasis after the first treatment but in one of 2 cases ol ileo-colonic anastomosis (20%) the bleeding relapsed and the patient was re-operated. In 1 patient with the self-limiting lower anastomotic bleeding was associated to a Dieulafoy's gastric ulcer, perendoscopic treated successfully. In summary 2 patients were resubmitted to laparotomy, without evidence of source of bleeding.
  
  
  CONCLUSIONS
  In accord with literature, bleeding from mechanical digestive anastomosis is a rare complication, often self-limiting (50-76%), that may be evidenced and treated early in intraoperative phase. Endoscopic examination may have diagnostic (source and type) and therapeutic valence, is effective, with low intrinsic risk and can reach endoscopic hemostasis without relaparotomy, except in case of rebleeding.
authors.affiliation: Università degli Studi di Palermo, Azienda Ospedaliera Policlinico P. Giaccone, Dipartimento di Chirurgia Generale, d'Urgenza e dei Trapianti d'Organo, Sezione di Chirurgia Generale ad indirizzo Toracico. carmesci@hotmail.com
authors.forename: Carmelo
authors.initials: C
authors.lastname: Sciumè
authors.forename: Girolamo
authors.initials: G
authors.lastname: Geraci
authors.forename: Franco
authors.initials: F
authors.lastname: Pisello
authors.forename: Francesco
authors.initials: F
authors.lastname: Li Volsi
authors.forename: Tiziana
authors.initials: T
authors.lastname: Facella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Modica
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies