Endoscopic Management of Postoperative Stapled Anastomosis Bleeding

62 Knowledge has evolved and the use of staplers in gastrointestinal surgery is now widespread. They are associated with low rates of postoperative complications. Postoperative anastomotic complications with stapling devices are relatively rare, with a reported incidence between 0 and 2.5%.1 A 38-year-old male patient was admitted to our department, because of high colored urine and yellowish discoloration of eyes for 6 months. The patient was otherwise healthy and had no previous history of bleeding disorders. Contrast-enhanced computed tomography (CECT) of abdomen showed a mass in the head of the pancreas. He underwent exploration and trial resection and it was found inoperable; palliative triple bypass was performed with liner stapler. On the 12th postoperative day, bleeding as diagnosed with features of postural hypotension and abdominal discomfort was followed by melena was reported. The patient was readmitted to hospital and required four units of blood transfusion in 48 hours. Because, the clinical picture did not improve, an uppergastrointestinal endoscopy was performed, with easy visualization of the bleeding site at the gastrojejunal stapler anastomotic site. The bleeding stopped after the application of two band ligation. An endoscopy was performed after 48 hours, with no further signs of bleeding. There was no further bleeding during 1 year of follow-up. Postoperative bleeding is a serious adverse effect, which may require additional emergency surgery. Postoperative hemorrhage is defined as significant bleeding (>100 ml/h) in letter to editor 10.5005/jp-journals-10018-1100