Massive XXXX after laparoscopic assisted abdominoperineal resection: a case report and systematic review of the literature.

@entity1 @entity548 @entity5 @entity190 @entity954 @entity1049
INTRODUCTION: The laparoscopic-assisted abdominoperineal resection (LAPR) has been proved to be associated with a shorter postoperative recovery, with equivalent oncological results and similar survival when compared with conventional open surgery, for @entity1 with @entity5 . METHOD: Case report of a massive @entity954 during LAPR and systematic review of the English language literature, using PubMed Medline, ISI Thopmson, OVID and EMBASE databases. RESULTS: 58 years old @entity1 admitted in emergency setting or @entity548 . Rectal examination revealed a protruding,frail @entity5 , located 2 cm from the anal verge. Total colono scopy revealed an infiltrative, protruding @entity5 , situated at 2 cm from the anal verge, with a 5 cm cranial extension,without any additional @entity1049 . Computed Tomography showed a 4,5 cm circumferential rectal wall thickening, without any enlarged mesorectal or abdominal lymph nodes. The @entity1 was transported to operating room for a LAPR. During final hemostasis, at the level of perineal surgical wound, an acute massive @entity548 occurred from the presacral vessels with severe @entity190 . This @entity548 couldnot be managed laparo scopicaly and conversion to laparotomywas decided, with pelvic packing. At 48 hours after the initial surgical approach, the tamponing packs were removed, without signs of active @entity548 . There were applied haemostatic agents and the perineal wound was sutured, without further rbleeding during in-hospital stay. CONCLUSIONS: A rapid and effective control of the @entity548 is mandatory to prevent a fatal outcome. Pelvic packing remains a life-saving procedure and the treatment of choice in severe cases.
