title: An unusual haemorrhagic complication of an anastomotic leak and a novel method of controlling the haemorrhage.
abstract: Introduction Restorative proctocolectomy (RP) is undertaken for patients with familial adenomatous polyposis (FAP) and ulcerative colitis, but is associated with a risk of anastomotic leak. Case history A 20-year-old male with a family history of FAP had a RP with a double-stapled J-pouch and covering loop ileostomy. At ileostomy reversal 21 months later, he presented with significant anal bleeding. He proceeded to theatre for endoscopy. Pouchoscopy showed a pouch full of blood and a foreign object trapped in a diverticulum. The foreign object (an undigested tablet) was removed with grasping forceps and the bleeding spot identified. Hemospray®(Cook Medical, Winston-Salem, NC, USA) was deployed in the bleeding cavity to enable immediate control of haemorrhage. Recovery was uneventful and he was discharged home 72 hours later. Conclusions This case: (i) demonstrates a successful and novel method of controlling haemorrhage not amenable to use of conventional haemostatic mechanisms; (ii) highlights the potential problems of using prolonged-release medications in patients with gastrointestinal strictures/diverticulae.
authors.affiliation: Emergency surgical unit, Royal Victoria Hospital, Grosvenor Road, Belfast , UK.
authors.forename: S
authors.initials: S
authors.lastname: Martin
authors.affiliation: Emergency surgical unit, Royal Victoria Hospital, Grosvenor Road, Belfast , UK.
authors.forename: A
authors.initials: A
authors.lastname: Armstrong
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D057868:Anastomotic Leak; D039021:Colonic Pouches; D004240:Diverticulum; D016099:Endoscopy, Gastrointestinal; D005547:Foreign Bodies / Q000150:complications / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007081:Ileostomy; D008297:Male; D008903:Minerals / Q000627:therapeutic use*; D016737:Proctocolectomy, Restorative; D012002:Rectal Diseases / Q000188:drug therapy* / Q000209:etiology; D013607:Tablets; D055815:Young Adult
chemical_list: D006490:Hemostatics; D008903:Minerals; D013607:Tablets; C581750:hemospray
keywords: Diverticulae; Hemospray®; Pouchoscopy; Restorative proctocolectomy