-- Liang Baosong
Bleeding after resection of an intestinal polyp is an overwhelming problem
A few days ago, our medical team admitted a 36-year-old young male patient. He because of diarrhea, 3 4 times a day, stools sometimes have blood, no abdominal pain, there is no sense of urgency, to the local hospital to do a colonoscopy, found in his ascending colon and the sigmoid colon there are two huge polyps, because he usually have high blood pressure, but also because of the fear of huge polyps resection risk is too great, so specifically came to my medical group, let us through the colonoscopy to give him minimally invasive surgery to the colon polyp Cutting it out.
After being admitted to the hospital, we gave him a basic examination about the need to remove colon polyps, comprehensively assessed his basic condition, ruled out various contraindications to surgery, and after preoperative discussion, we gave him a surgical plan to firstly clip the polyp with titanium clamps at the root of the polyp, and then use the high-frequency electric collar to encircle, cut, and recycle the polyp for pathologic examination.
That day's surgery, operated by my secondary physician, Zhang Haihui, personally, inserted colonoscopy process, in the sigmoid colon found a diameter of 25mm long tip polyp, in the ascending colon found another diameter of 20mm long tip polyp. Zhang Haihui firstly did a white light examination of the polyp, and then used the NBI and magnification function to make a detailed observation of the polyp's glandular duct opening pattern, which was considered to be a benign polyp with a high likelihood, in line with the indications for endoscopic surgical resection, according to the pre-operative discussion of the pre-program, Zhang Haihui respectively gave the two huge polyp roots with titanium clips, to avoid the bleeding of the polyp's trophic blood vessels during the surgical cuts, and then put a set of titanium clips close to the side of the polyp. The side of the polyp set on the trap, electrified, complete polyp cut down, observe the polyp stump without bleeding, polyp recycling sent to the pathology check, the whole operation is clean, can be called a textbook-like operation.
The patient returned to the ward, our bedside physician first viewed the patient, the patient did not have blood in the stool, there is no abdominal pain, physical examination of the abdomen, there is no pressure, rebound pain and muscle tension, percussion liver turbid tone boundary normal. Check the patient's heart rate and blood pressure, there is no obvious abnormality, according to the requirements of the patient was instructed to bed rest, fasting.
The second day of observation, the patient is all normal, just as we are ready to let the patient start eating on the third day, the morning shift of the doctor explained that the patient defecated once in the early morning, there is red blood in the inside, my first-class physician Lu Xiaodan said: "Director Liang, we have that patient who removed a huge polyp postoperative bleeding, you see if you need to do colonoscopy again immediately! Do you think it is necessary to perform another colonoscopy immediately to stop the bleeding? I've already notified Mr. Zhang Haihui to get him ready!" "Don't be in a hurry, now come with me to see the patient before we talk."
Coming to the ward with Dr. Lu Xiaodan, I asked the patient directly, "When did you relieve your bowels? How many times? What color is it? There are no blood clots in it? When you are relieving your bowels, do you have dizziness, panic, sweating?"
"I relieved my stool this morning, just twice, dark red color, with stool, with blood, no blood clot in it, there was no dizziness, panic, sweating at that time, and I don't feel anything now."
"Do you usually have high blood pressure, have you taken aspirin, Polivir, hemosiderin, or have you taken health care products? Drugs and supplements like that can affect clotting, and I need to reconfirm that."
"None of those were taken, you all asked about that pre-op."
I told Dr. Lu Xiaodan, "This patient's giant polyp was resected endoscopically, and I've viewed the pictures of the endoscopic treatment, and the titanium clips were clamped in a good position, and it's possible that the resected stump is oozing blood on the surface, and now the patient has no clot in the stool, and there's a small possibility of bleeding from the blood vessels, and once again, to make sure that there was no anticoagulant medication applied, and that the blood oozing won't be too long, and it should be able to stop on its own! The patient should be able to stop bleeding on his own. The presence of blood clot is very important, vascular bleeding often have blood clot, often need immediate endoscopic hemostasis, now the patient's vital signs are stable, you can prolong the fasting time, close observation of the patient's stool frequency and color, if the number of stools is more and more, shorter and shorter intervals, more and more brightly colored blood, blood pressure and pulse rate is unstable, suggesting that the bleeding continues, the need for immediate endoscopic re-treatment, on the contrary, suggests that bleeding has stopped. , indicating that the bleeding has stopped, observation can be!"
Since I checked in, the patient has no more blood in the stool, and has now passed normal-colored stools, at this moment, we can already say that the patient's treatment has been a complete success! At this moment, we can already say that the patient's treatment has been a complete success! However, when the patient had blood in the stool after the operation, do you know how torn we were? If we choose to have another colonoscopy immediately, the patient needs to endure the pain again and spend more money; if we choose to observe the patient conservatively, in case the bleeding is serious and the condition is delayed, will the patient understand? So the doctor, every day, is in a tangle of right and left dilemmas. Whenever such a risk, I need to come forward to do the decision maker, not only because I am the oldest, the most senior, more experience, the highest title, but also because I am an old man, the need to play the role of the "sea god", I need to protect my subordinate physicians, medical responsibility, in the critical time to come forward!
Often, patients will say, "Director Liang's judgment is divine! I have to be realistic and tell you that I'm just an ordinary person, and the National Weather Service has so many experts, so much advanced equipment, and so much full meteorological history to refer to, and the weather forecasts that come out of the consultation can still be wrong, not to mention the empirical decision-making of my kind. Therefore, please understand if I have made any mistakes in decision-making! (Liang Baosong, chief consultant, graduated from Henan Medical University in 1984 and is a professor and chief physician of the gastroenterology department at Henan Provincial People's Hospital.