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

We describe the case of a delayed bleeding that occurred concomitantly with an abdominoperineal resection. The patient underwent endoscopy without apparent complications. During surgery, and in the immediate postoperative hours, 4 blood units were required to achieve stable conditions even if the surgical technique was correct, no major bleeding occurred and no blood was seen inside the lumen at bowel transection. On the 7th postoperative day (9th from polypectomy) the patient shocked for the first time. Two days later, massive clots appeared from the stoma and he shocked again. CT scan found the bleeding occurring from the polypectomy site and angiographic embolization finally ended the hemorrhage. The increased risk of delayed hemorrhages and their dramatic clinical manifestations render the post-polypectomy "window" period worth to be followed-up strictly. We believe that further invasive procedures, especially major surgery, should be postponed unless emergent and necessary to save the patient's life.