Post-endoscopic polypectomy delayed bleeding concomitant with an abdominoperineal resection: a case report.

Area of Science:

• Gastroenterology and Surgical Oncology
• Gastrointestinal Hemorrhage Management

Background:

• Abdominoperineal resection (APR) is a major surgical procedure for rectal conditions.
• Polypectomy, a common endoscopic procedure, carries a small risk of delayed complications.
• Hemorrhage is a known postoperative complication, but delayed, severe bleeding is less common.

Observation:

• A patient undergoing APR experienced significant bleeding requiring blood transfusions immediately post-surgery, despite a technically correct procedure.
• The patient developed severe, life-threatening hemorrhage on postoperative day 7, manifesting as massive clots from the stoma.
• Computed tomography (CT) scan identified the bleeding source originating from a previous polypectomy site.

Findings:

• Delayed hemorrhage occurred 9 days post-polypectomy and concomitantly with APR.
• Bleeding was successfully managed with CT-guided angiographic embolization.
• The case highlights a potential link between polypectomy and delayed bleeding, exacerbated by major surgery.

Implications:

• The post-polypectomy period represents a critical 'window' for potential delayed hemorrhages.
• Close monitoring and follow-up are essential for patients with a history of polypectomy, especially preceding major surgery.
• Elective invasive procedures, including major surgery, should be carefully considered and potentially postponed in the context of recent polypectomy to mitigate hemorrhage risk.