Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_40_библиотеки_им_акад_М_И_Перельмана

Low- risk procedures:omit on the morning of procedure High- risk procedures:stop 48 hours before procedure (72 hours for dabigatran with CrCl 30– 50 ml/ min)

• If high- risk condition, stop ve days before procedure and bridge with low molecular weight heparin (LMWH)

• Occurs more commonly in larger polypectomies (>2cm)

• Is managed conservatively in the majority of cases

The most likely diagnosis in this case is post- polypectomy syndrome (or post- polypectomy electrocoagulation syndrome). The electrical current arising from diathermy extends beyond the mucosa and muscularis propria into the serosal surface of the colon. Thermal injury ensues, without evidence of colonic perforation, and results in a localized inammatory reaction. The syndrome occurs after large amounts of sustained thermal energy have been applied, so it is more commonly seen after larger polypectomies (>2cm in diameter), or when normal mucosa is inadvertently caught within the snare alongside the polyp. Anecdotal evidence suggests the injection of uid submucosally prior to polypectomy may reduce the risk of developing post- polypectomy syndrome.

The ESGE and United European Gastroenterology have identied quality of endoscopy as a major priority. They recommend that endoscopy services adopt the following key performance measures for ERCP and EUS:

All patients should receive written information explaining the procedure, and its intended benets and risks, in a format that they can understand. Written information should be provided in advance of the procedure. The consent process should be performed by a suitably trained individual before entry into the procedure room. Final validation of the consent process should be completed before the procedure starts. Endoscopic photo- and video- documentation as part of routine clinical care does not require additional consent. If a patient, with capacity, withdraws consent during an endoscopic procedure, the procedure should be stopped. The person’s concerns should be explored. If they clearly indicate a wish for the procedure to be discontinued, this must occur without delay unless doing so would result in a risk of serious harm to the patient.

Intussusception is the invagination of one segment of bowel into an immediately adjacent segment. It is most commonly found in children and represents the second most common cause of intestinal obstruction in this group after pyloric stenosis. The majority of paediatric intussusception is idiopathic (90%) and is usually ileocolic. Conversely, adult intussusception is rare, accounting for 1– 5% of cases of bowel obstruction and usually occurs in the ileum. Ninety per cent of adult cases will have an underlying structural cause, two- thirds of which will be due to benign or malignant neoplasms. The remainder are caused by infections, adhesions, intestinal ulceration, and congenital abnormalities such as Meckel’s diverticulum. These lesions act as a focal area of traction, or ‘lead point’, which draws the proximal bowel within the peristalsing distal bowel, which can ultimately lead to bowel ischaemia and perforation. Intussusception in adults is usually diagnosed on CT, which classically demonstrates a concentric hyperdense double ring or ‘target- sign’. In children, most ileocolic intussusception is successfully managed with ultrasound or uoroscopy guided pneumatic/ hydrostatic enema. In adults, because of the majority of cases arising from structural pathology in the small bowel, surgery remains the mainstay of treatment.