BACKGROUND: Acute (<24 h) staple line bleeding is not common but a known complication after bariatric surgery at a rate of 1-3%. In most cases, acute postoperative bleeding is mild and can be managed conservatively. Nonetheless, there are times when massive hemorrhage is encountered. Endoscopic treatment of these patients within 24 h of Roux-en-Y (RYGB) is controversial, due to fear of staple line dehiscence and/or perforation. Therefore, most surgeons prefer to undergo diagnostic laparoscopy for exploration and treatment. However, it has been reported that laparoscopic management of acute bleeding can be technically challenging with a high rate of morbidity as well as conversion to laparotomy. We herein present a multimedia video (6 min) demonstrating the management of acute massive hemorrhage after RYGB. METHODS: A 46-year-old female with hemodynamic instability after massive hematemesis and melena underwent endoscopy. An overtube was utilized to allow removal of large blood clots which obstructed endoscopic visualization. Two bleeding points were noted, and these were successfully treated with adrenaline and endoscopic clips. RESULTS: The patient rapidly improved during her hospital stay and commenced oral intake on day 1. A surveillance endoscopy was performed on day 5, and no stigmata of recent bleeding was noted. She was discharged home and is progressing well. CONCLUSIONS: We suggest endoscopy is an appropriate first step for the investigation and management of acute intraluminal bleeding post bariatric surgery.
BACKGROUND: Acute (<24 h) staple line bleeding is not common but a known complication after bariatric surgery at a rate of 1-3%. In most cases, acute postoperative bleeding is mild and can be managed conservatively. Nonetheless, there are times when massive hemorrhage is encountered. Endoscopic treatment of these patients within 24 h of Roux-en-Y (RYGB) is controversial, due to fear of staple line dehiscence and/or perforation. Therefore, most surgeons prefer to undergo diagnostic laparoscopy for exploration and treatment. However, it has been reported that laparoscopic management of acute bleeding can be technically challenging with a high rate of morbidity as well as conversion to laparotomy. We herein present a multimedia video (6 min) demonstrating the management of acute massive hemorrhage after RYGB. METHODS: A 46-year-old female with hemodynamic instability after massive hematemesis and melena underwent endoscopy. An overtube was utilized to allow removal of large blood clots which obstructed endoscopic visualization. Two bleeding points were noted, and these were successfully treated with adrenaline and endoscopic clips. RESULTS: The patient rapidly improved during her hospital stay and commenced oral intake on day 1. A surveillance endoscopy was performed on day 5, and no stigmata of recent bleeding was noted. She was discharged home and is progressing well. CONCLUSIONS: We suggest endoscopy is an appropriate first step for the investigation and management of acute intraluminal bleeding post bariatric surgery.
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Authors: Belinda De Simone; Elie Chouillard; Almino C Ramos; Gianfranco Donatelli; Tadeja Pintar; Rahul Gupta; Federica Renzi; Kamal Mahawar; Brijesh Madhok; Stefano Maccatrozzo; Fikri M Abu-Zidan; Ernest E Moore; Dieter G Weber; Federico Coccolini; Salomone Di Saverio; Andrew Kirkpatrick; Vishal G Shelat; Francesco Amico; Emmanouil Pikoulis; Marco Ceresoli; Joseph M Galante; Imtiaz Wani; Nicola De' Angelis; Andreas Hecker; Gabriele Sganga; Edward Tan; Zsolt J Balogh; Miklosh Bala; Raul Coimbra; Dimitrios Damaskos; Luca Ansaloni; Massimo Sartelli; Nikolaos Parasas; Yoram Kluger; Elias Chahine; Vanni Agnoletti; Gustavo Fraga; Walter L Biffl; Fausto Catena Journal: World J Emerg Surg Date: 2022-09-27 Impact factor: 8.165