Department of Surgery, Military Medical Academy, 1606 Sofia, Bulgaria.
Institute of Legal Medicine, University of Camerino, 62032 Camerino, Italy.
Medicina (Kaunas). 2020 May 29;56(6):269. doi: 10.3390/medicina56060269.
: The present study aims to assess the effectiveness and current evidence of the treatment of perirectal bleeding after stapled haemorrhoidopexy. : 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. : 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. : 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.
: 本研究旨在评估吻合器痔上黏膜环切钉合术后直肠周围出血的治疗效果和现有证据。: 进行了系统的文献回顾，结合了已发表和通过搜索 PubMed、Web of Science 和 SCOPUS 获得的原始数据。: 本系统综述包括 16 篇文章和 37 名患者。12 篇文章报告直肠周围出血，6 篇报告腹腔内出血。吻合器痔上黏膜环切钉合术（SH）在 57%的病例中进行（3 例 PPH 01 和 15 例 PPH 03），吻合器经肛直肠切除术（STARR）在 13%的病例中进行，30%的信息不可用。中位年龄为 49 岁（±11.43）。直肠周围出血的体征和症状为腹痛（43%）、盆腔不适无直肠出血（36%）、尿潴留（14%）和外部直肠出血（21%）。中位出血时间为 1 天（±1.53 术后天数），诊断时中位血红蛋白为 8.8±1.04g/dL。报道有 19%的患者存在不稳定的血流动力学。77%的患者首先进行了计算机断层扫描（CT）检查。只有 2 例进行了腹部超声检查，但随后也进行了 CT 扫描。非手术治疗在 38%（n=14）的患者中进行，其中 2 例选择性动脉造影和经皮血管内栓塞。23 例患者进行了手术治疗 - 经腹手术（3 例结肠造口术、1 例 Hartmann 手术、1 例直肠低位前切除术、1 例双侧髂内动脉结扎术和 1 例直肠壁血管结扎术）、经肛门手术（n=13）、1 例经会阴切口、1 例 CT 引导下尾骨旁引流。: 由于罕见且缺乏经验，文献中尚无直肠周围血肿治疗的统一策略。我们提出了一种类似于骨盆创伤处理方法的算法，基于两个主要支柱 - 血流动力学稳定性和 CT 对比的发现。
