Cargando…

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 af...

Descripción completa

Detalles Bibliográficos
Autores principales: Popivanov, Georgi, Fedeli, Piergiorgio, Cirocchi, Roberto, Lancia, Massimo, Mascagni, Domenico, Giustozzi, Michela, Teodosiev, Ivan, Kjossev, Kirien, Konaktchieva, Marina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353849/
https://www.ncbi.nlm.nih.gov/pubmed/32486112
http://dx.doi.org/10.3390/medicina56060269
_version_ 1783557969542119424
author Popivanov, Georgi
Fedeli, Piergiorgio
Cirocchi, Roberto
Lancia, Massimo
Mascagni, Domenico
Giustozzi, Michela
Teodosiev, Ivan
Kjossev, Kirien
Konaktchieva, Marina
author_facet Popivanov, Georgi
Fedeli, Piergiorgio
Cirocchi, Roberto
Lancia, Massimo
Mascagni, Domenico
Giustozzi, Michela
Teodosiev, Ivan
Kjossev, Kirien
Konaktchieva, Marina
author_sort Popivanov, Georgi
collection PubMed
description 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.
format Online
Article
Text
id pubmed-7353849
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-73538492020-07-21 Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm Popivanov, Georgi Fedeli, Piergiorgio Cirocchi, Roberto Lancia, Massimo Mascagni, Domenico Giustozzi, Michela Teodosiev, Ivan Kjossev, Kirien Konaktchieva, Marina Medicina (Kaunas) Review 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. MDPI 2020-05-29 /pmc/articles/PMC7353849/ /pubmed/32486112 http://dx.doi.org/10.3390/medicina56060269 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Popivanov, Georgi
Fedeli, Piergiorgio
Cirocchi, Roberto
Lancia, Massimo
Mascagni, Domenico
Giustozzi, Michela
Teodosiev, Ivan
Kjossev, Kirien
Konaktchieva, Marina
Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm
title Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm
title_full Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm
title_fullStr Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm
title_full_unstemmed Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm
title_short Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm
title_sort perirectal hematoma and intra-abdominal bleeding after stapled hemorrhoidopexy and starr—a proposal for a decision-making algorithm
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353849/
https://www.ncbi.nlm.nih.gov/pubmed/32486112
http://dx.doi.org/10.3390/medicina56060269
work_keys_str_mv AT popivanovgeorgi perirectalhematomaandintraabdominalbleedingafterstapledhemorrhoidopexyandstarraproposalforadecisionmakingalgorithm
AT fedelipiergiorgio perirectalhematomaandintraabdominalbleedingafterstapledhemorrhoidopexyandstarraproposalforadecisionmakingalgorithm
AT cirocchiroberto perirectalhematomaandintraabdominalbleedingafterstapledhemorrhoidopexyandstarraproposalforadecisionmakingalgorithm
AT lanciamassimo perirectalhematomaandintraabdominalbleedingafterstapledhemorrhoidopexyandstarraproposalforadecisionmakingalgorithm
AT mascagnidomenico perirectalhematomaandintraabdominalbleedingafterstapledhemorrhoidopexyandstarraproposalforadecisionmakingalgorithm
AT giustozzimichela perirectalhematomaandintraabdominalbleedingafterstapledhemorrhoidopexyandstarraproposalforadecisionmakingalgorithm
AT teodosievivan perirectalhematomaandintraabdominalbleedingafterstapledhemorrhoidopexyandstarraproposalforadecisionmakingalgorithm
AT kjossevkirien perirectalhematomaandintraabdominalbleedingafterstapledhemorrhoidopexyandstarraproposalforadecisionmakingalgorithm
AT konaktchievamarina perirectalhematomaandintraabdominalbleedingafterstapledhemorrhoidopexyandstarraproposalforadecisionmakingalgorithm