ANASTOMOTIC ULCERATION AS A SOURCE OF OBSCURE GI BLEEDING IN PATIENTS AFTER SMALL BOWEL RESECTION

Aims:

Anastomotic ulceration (AU) in the late period after small bowel (SB) resection as a rare source of obscure bleeding has become more evident after implementation of videocapsule endoscopy (VCE) and balloon-assisted enteroscopy (BAE), but still insufficiently studied. The aim is to evaluate the clinical features, etiology and treatment outcomes of the patients with AU of SB.

Methods:

From 14.02.2007 to 30.10.2017 AU was revealed in 8 (3,7%) pts. (m-7, f-1, mean age 38,0 ± 14,4 years, range 19 – 59) from 213 patients who admitted to our hospital with suspected SB bleeding. The interval between SB resection (made for different reasons except IBD) and first signs of bleeding varied from 1 to 28 years (mean 11,2 ± 8,4 years). There were 7 (87,5%) pts. with obscure overt and 1 (12,5%) with obscure occult bleeding. Recurrent bleedings occurred in 7 pts.: multiple in 4, twice in 1, once in 2 pts. VCE was performed in 6 (75,0%) pts.; BAE in all pts.

Results:

VCE and BAE revealed ulcers from 5 to 25 mm in size at the anastomotic area in 5 pts. and in the blind loop nearby anastomosis in 3 pts.; including stenosis of the lumen in 2 pts. It was confirmed that IBD wasn't the reason for the ulceration. Small bowel reresection was performed in 7 pts. (including 2 pts. with unsuccessful conservative treatment); iron supplementation – in 1 pt. who refused surgery. Histology showed acute and chronic ulcers, including suture material in the ulcer bases of 2 pts. All patients have been free of relapseand anemiafrom 1 to 7 years after surgery.

Conclusions:

AU can be a source of obscure bleeding in patients after SB resection. One of possible factors leading to AU is suture material. There is no standardized approach to the management of anastomotic ulcers, surgical reoperation tends to be the effective treatment option.