POSTOPERATIVE BLEEDING IN PEDIATRIC PATIENTS WITH SHORT BOWEL SYNDROME
Bildiriler > Tam Metin Bildiri · 2025
Yazarlar: Melis CEVHERTAŞ, Ülgen ÇELTİK, Samir HASAN, EZGİ KIRAN TAŞCI, Cengiz ŞAHUTOĞLU, Miray KARAKOYUN, Ahmet ÇELİK
8th World Congress of Pediatric Surgery, Türkiye, Antalya, Uluslararası, Sözlü Sunum, Tam Metin Bildiri, 2025-2025, ss 1-1
Özet
<p>Aim: In patients with short bowel syndrome(SBS),tendency toward postoperative bleeding may occur despite</p><p>normal preoperative International Normalized Ratio(INR) and platelet counts,possibly due to long-term TPNassociated</p><p>liver dysfunction or malabsorption,although exact mechanism remains unclear.We aimed to</p><p>evaluate postoperative bleeding in SBS patients undergoing intestinal surgery and identify potential risk</p><p>factors associated with bleeding.</p><p>Methods: A retrospective review was conducted on SBS patients who underwent surgery between 2015</p><p>and 2024.Data collected including age,weight,primary diagnosis,bowel length,presence of terminal</p><p>ileum,preoperative INR,platelet levels,operative durations.Patients who experienced postoperative bleeding</p><p>were further analyzed as separate subgroup.Multivariate logistic regression’s performed to identify risk factors</p><p>associated with postoperative bleeding by comparing bleeding-non-bleeding patients.</p><p>Results: A total of 47 surgically treated SBS patients’re included in the study.Primary diagnoses included</p><p>intestinal atresia(n=16), NEC(n=10), volvulus(n=10), Hirschsprung disease(n=5), other rare causes(n=6).</p><p>Surgical procedures included intestinal lengthenings(n:18),stoma closures(n:13),resections-anastomoses</p><p>(n:8),ileostomy(n:6),Ladd procedures(n:2).No intraoperative vascular injury or active bleeding’s observed.</p><p>Postoperative bleeding occurred in 6 patients(12.8%), all of whom’d normal preoperative INR and fibrinogen.</p><p>ROC analysis revealed that preoperative INR >1.15 predicted bleeding with 83% sensitivity and 56%</p><p>specificity(AUC = 0.72).Multivariate logistic regression including INR, weight, bowel length,presence of</p><p>terminal ileum, operation durations revealed no statistically significant predictors.Clinically,higher INR</p><p>and lower weight appeared associated with increased bleeding risk.Five of six bleeding patients lacked</p><p>terminal ileum and ileocecal valve(p = 0.221).No significant association’s found between fat-soluble vitamin</p><p>deficiencies and bleeding.One patient required reoperation due to uncontrolled hemorrhage, while others ‘re</p><p>managed medically.</p><p>Conclusion: Postoperative bleeding may occur in SBS patients despite normal coagulation tests.Standard</p><p>tests may not be sufficient alone.Further studies are warranted to clarify underlying mechanisms and improve</p><p>risk prediction.</p><p>Keywords: Short Bowel Syndrome, Postoperative Bleeding, Fibrinogen, Coagulopathy, INR (International</p><p>Normalized Ratio)</p>