Transrectal ultrasound (TRUS)-guided prostate core biopsy is a very
useful diagnostic tool in urological diseases. It constitutes a simple and safe
outpatient procedure in the majority of patients, although hemorrhagic
complications, ranging from transient hematuria to catastrophic rectal
bleeding, may occur [1].
Rectal bleeding affects up to 50 % of patients,
although only 1 % of these patients present with hemodynamic
instability requiring blood transfusion support [2]
[3]. Endoscopic haemostatic measures present an efficient,
noninvasive method to control these kinds of serious events [2]
[3]
[4]
[5].
Case 1
Case 1
A 71-year-old man presented at the emergency department with rectal
bleeding since the past 12 hours. He had undergone TRUS-guided prostate biopsy
10 days previously and was on long-term aspirin therapy. He was pale and
tachycardic. His hematocrit was 23 %, and platelet count and
coagulation parameters were normal.
Two units of packed red blood cells were transfused. On colonoscopy,
an adherent blood clot was visualized on the anterior rectal wall near the anal
verge. Aspiration of the blood clot revealed a blood vessel ([Fig. 1 a]).
Fig. 1 a Blood vessel
visualized on the anterior rectal wall. b Elastic band
ligation (EBL) being carried out.
The bleeding was stopped by administering adrenaline 10 mL
(1 / 10 000) plus 4 mL polidocanol (Aethoxysklerol
1 % sclerosing agent; Chemische Fabrik, Kreussler GmbH, Germany),
However, the bleeding restarted 24 hours later. Elastic band ligation (EBL) was
then carried out, which resolved the situation ([Fig. 1 b]).
Case 2
Case 2
A 62-year-old man was admitted to the emergency department following
TRUS-guided prostate biopsy performed 2 hours earlier. The hemorrhage was not
contained by digital compression or rectal packing. The patient was
hemodynamically stable and hematologic analysis did not show a marked drop in
hematocrit (42.6 % to 38.4 %). Urgent colonoscopy
was carried out, which revealed active bleeding from the biopsy site in the
anterior rectal wall ([Fig. 2 a]), which
was easily controlled with argon plasma coagulation (APC) ([Fig. 2 b]).
Fig. 2 a Blood vessel oozing
blood near the anal verge. b Bleeding controlled with
argon plasma coagulation (APC).
In conclusion, irrespective of its accuracy, every endoscopic
technique has a margin of error occasionally demanding combination therapy. In
this particular context, both APC and EBL were effective.
Endoscopy_UCTN_Code_CPL_1AL_2AZ
Endoscopy_UCTN_Code_CPL_1AL_2AF
