Challenging delayed bleeding after an Ivor Lewis oesophagectomy. Issue 12 (17th December 2020)

• Record Type: Journal Article
• Authors: Liddle, Sean; Mirakhur, Anirudh; Debru, Estifanos
• Is Part Of: Journal of surgical case reports. Volume 2020:Issue 12(2020)
• Publication Date: 2020-12-17
• Subjects: oesophagectomy -- Ivor lewis -- oesophageal cancer -- angiography -- haematemesis; Surgery -- Periodicals; Surgery -- Case studies -- Periodicals; 617.005
• DOI: 10.1093/jscr/rjaa471
• Languages: English
• ISSNs: 2042-8812

Abstract

Abstract: A 66-year-old man underwent a minimally invasive oesophagectomy for oesophageal adenocarcinoma. Surgery and recovery were routine; however, he represented 8 days later with a massive upper gastrointestinal bleed. He was stabilized, but over a 2-week period experienced several bleeds requiring transfusion and multiple endoscopies, all showing a prominent luminal vessel at the oesophago-gastric (OG) anastomosis. Haemostatic clipping was attempted resulting in pulsatile bleeding and transfer to the radiology suite where angiography showed extravasation of contrast at the OG anastomosis from the terminal portion of the gastro-epiploic arcade. Coil embolization was successful and did not result in ischaemia. It was our standard to construct the OG anastomosis with the end-to-end anastomosis circular stapler (DST™ Series EEA™), 4.8-mm staple height. However, we now use the 3.5-mm staple height for improved haemostasis and ensure that the area for anastomosis is cleared of omental tissue so as not to incorporate a visible vessel.