title: Postoperative small bowel and colonic anastomotic bleeding. Therapeutic management and complications.
abstract: BACKGROUND
  Postoperative small bowel or colic anastomotic bleeding (PSCAB) is often a mild complication and is generally treated by a conservative approach. Other therapeutic options are surgery, endoscopic management and angiographic embolization. Our aim is to review our cases of postoperative anastomotic bleeding in patients with small bowel or colic anastomosis, with special attention to their treatment and complications.
  
  
  METHODS
  Observational retrospective study including patients with PSCAB in the department of General and Digestive Surgery in Vall d'Hebron University Hospital, between 2007 and 2012. Demographic and bleeding characteristics as well as therapeutic management were reviewed, including complications derived from the different therapeutic options.
  
  
  RESULTS
  There were 44 cases of bleeding after performing small bowel or colic anastomosis, 25 patients were men (56.8%), with a mean age of 68.2 years (R: 28-92). The mean hematocrit decrease was 8 points (R: 0-17), and hemodynamic instability was detected in 13 patients (29.5%). A conservative management was undertaken in 27 patients (61.3%), surgery in 6 (13.6%), endoscopic treatment in 2 (4.5%) and embolization in 9 (20.5%). 4 patients of cases treated with embolization presented anastomotic leak (44.5%). Mortality was 13.6% (6 patients). A total of 4 of 6 deaths were in the group of patients treated with embolization.
  
  
  CONCLUSIONS
  Most patients with PSCAB have a good response to conservative management. When there is failure of this approach, there are different therapeutic options, including angiographic embolization. In our series, we have seen a high incidence of post embolization anastomotic leak; further trials will be necessary to provide valuable evidence of the risk of this therapeutic option.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Vall d́Hebron, Barcelona, España. Electronic address: efsevilla@gmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: Fernández de Sevilla Gómez
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Vall d́Hebron, Barcelona, España.
authors.forename: Francesc
authors.initials: F
authors.lastname: Vallribera Valls
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Vall d́Hebron, Barcelona, España.
authors.forename: Eloy
authors.initials: E
authors.lastname: Espin Basany
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Vall d́Hebron, Barcelona, España.
authors.forename: Silvia
authors.initials: S
authors.lastname: Valverde Lahuerta
authors.affiliation: Unidad de Angioradiología, Hospital Universitario Vall d'Hebron, Barcelona, España.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Pérez Lafuente
authors.affiliation: Unidad de Angioradiología, Hospital Universitario Vall d'Hebron, Barcelona, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Segarra Medrano
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Vall d́Hebron, Barcelona, España.
authors.forename: Manel
authors.initials: M
authors.lastname: Armengol Carrasco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000628:therapy*; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000209:etiology* / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies
keywords: Anastomosis quirúrgica; Anastomotic leak; Dehiscencia de sutura; Embolización terapéutica; Gastrointestinal bleeding; Sangrado gastrointestinal; Surgical anastomosis; Therapeutic embolization