Early Postoperative Anastomotic Obstruction Due to an Intraluminal Blood Clot After Laparoscopic Anterior Resection: A Case Report

Overview

Journal Ann Coloproctol

Date 2020 Nov 18

PMID 33207114

Authors

Soon Keun Kwon

Jin Soo Han

Jihyun Seo

Yong Sik Yoon

Affiliations

Soon will be listed here.

Abstract

Early postoperative anastomotic obstruction after colorectal surgery rarely develops. Herein, we present a case of a 50-year-old healthy woman who had an early postoperative anastomotic obstruction which was revealed caused by a blood clot and successfully managed by endoscopic approach. The patient was discharged after laparoscopic anterior resection and visited the emergency department one day after because of abdominal pain. Computed tomography showed that the anastomosis site was obstructed with low-density material. Intraoperative endoscopy was performed under general anesthesia and blood clot filling the lumen were identified. As the scope was advanced to the blood clot with air inflation, the blood clot was evacuated. The anastomosis site could be obstructed by blot clot with mucous debris albeit it is a rare condition. An endoscopic approach seems to be the first option in the diagnosis and treatment of postoperative obstruction at the anastomosis site and it could prevent unnecessary laparotomy.

References

Martinez-Serrano M, Pares D, Pera M, Pascual M, Courtier R, Egea M . Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis. Tech Coloproctol. 2009; 13(1):49-53. DOI: 10.1007/s10151-009-0458-6. View

Knol H, Kemperman R, Kluin-Nelemans H, Mulder A, Meijer K . Haemostatic variables during normal menstrual cycle. A systematic review. Thromb Haemost. 2011; 107(1):22-9. DOI: 10.1160/TH11-07-0481. View

Felsher J, Brodsky J, Brody F . Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surgery. 2003; 134(3):501-5. DOI: 10.1067/s0039-6060(03)00251-4. View

Ishihara S, Watanabe T, Nagawa H . Intraoperative colonoscopy for stapled anastomosis in colorectal surgery. Surg Today. 2008; 38(11):1063-5. DOI: 10.1007/s00595-007-3740-0. View

Lawrence J, Leifer D, Moura G, Southern P, Emery J, Bodenheimer S . Sex differences in platelet adherence to subendothelium: relationship to platelet function tests and hematologic variables. Am J Med Sci. 1995; 309(4):201-7. DOI: 10.1097/00000441-199504000-00003. View

Lee S, Park Y, Sohn S . Successful colonoscopic decompression of colon after development of an early postoperative obstruction at the stapled anastomosis after an anterior colectomy and early chemotherapy: a case report. Surg Laparosc Endosc Percutan Tech. 2007; 17(1):65-7. DOI: 10.1097/01.sle.0000213758.61514.85. View

Schwertz D, Penckofer S . Sex differences and the effects of sex hormones on hemostasis and vascular reactivity. Heart Lung. 2001; 30(6):401-26; quiz 427-8. DOI: 10.1067/mhl.2001.118764. View

Awais O, Raftopoulos I, Luketich J, Courcoulas A . Acute, complete proximal small bowel obstruction after laparoscopic gastric bypass due to intraluminal blood clot formation. Surg Obes Relat Dis. 2006; 1(4):418-22. DOI: 10.1016/j.soard.2005.04.004. View

Pazouki A, Pakaneh M, Khalaj A, Tamannaie Z, Jangjoo A, Shapoori P . Blood bezoar causing obstruction after laparoscopic Roux-en-Y gastric bypass. Int J Surg Case Rep. 2014; 5(4):183-5. PMC: 3980510. DOI: 10.1016/j.ijscr.2013.12.022. View

10.

Green J, Ikuine T, Hacker S, Urrego H, Tuggle K . Acute small bowel obstruction due to a large intraluminal blood clot after laparoscopic Roux-en-Y gastric bypass. J Surg Case Rep. 2016; 2016(8). PMC: 4994514. DOI: 10.1093/jscr/rjw143. View

11.

Peeters G, Gys T, Lafullarde T . Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass caused by an intraluminal blood clot. Obes Surg. 2008; 19(4):521-3. DOI: 10.1007/s11695-008-9575-y. View

12.

Soricelli E, Facchiano E, Quartararo G, Beltrame B, Leuratti L, Lucchese M . Large Hemobezoar Causing Acute Small Bowel Obstruction After Roux-en-Y Gastric Bypass: Laparoscopic Management. Obes Surg. 2017; 27(7):1906-1907. DOI: 10.1007/s11695-017-2708-4. View

13.

Alves A, Panis Y, Mathieu P, Mantion G, Kwiatkowski F, Slim K . Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg. 2005; 140(3):278-83, discussion 284. DOI: 10.1001/archsurg.140.3.278. View

14.

Ellozy S, Harris M, Bauer J, Gorfine S, Kreel I . Early postoperative small-bowel obstruction: a prospective evaluation in 242 consecutive abdominal operations. Dis Colon Rectum. 2002; 45(9):1214-7. DOI: 10.1007/s10350-004-6395-6. View