WOFAPS 2025 8th World Congress of Pediatric Surgery

Melis Cevhertaş ¹, Ülgen Çeltik ¹, Samir Hasan ¹, Ezgi Kıran Taşcı ², Cengiz Şahutoğlu ³, Miray Karakoyun ², Ahmet Çelik ¹

¹ Ege University Faculty of Medicine Department of Pediatric Surgery
² Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology
³ Ege University Faculty of Medicine, Department Of Anesthesiology

Aim:
In patients with short bowel syndrome(SBS),tendency toward postoperative bleeding may occur despite normal preoperative International Normalized Ratio(INR) and platelet counts,possibly due to long-term TPN-associated liver dysfunction or malabsorption,although exact mechanism remains unclear.We aimed to evaluate postoperative bleeding in SBS patients undergoing intestinal surgery and identify potential risk factors associated with bleeding.

Methods:
A retrospective review was conducted on SBS patients who underwent surgery between 2015 and 2024.Data collected including age,weight,primary diagnosis,bowel length,presence of terminal ileum,preoperative INR,platelet levels,operative durations.Patients who experienced postoperative bleeding were further analyzed as separate subgroup.Multivariate logistic regression's performed to identify risk factors associated with postoperative bleeding by comparing bleeding-non-bleeding patients.

Results:

A total of 47 surgically treated SBS patients're included in the study.Primary diagnoses included intestinal atresia(n=16), NEC(n=10), volvulus(n=10), Hirschsprung disease(n=5), other rare causes(n=6).Surgical procedures included intestinal lengthenings(n:18),stoma closures(n:13),resections-anastomoses(n:8),ileostomy(n:6),Ladd procedures(n:2).No intraoperative vascular injury or active bleeding's observed.Postoperative bleeding occurred in 6 patients(12.8%), all of whom'd normal preoperative INR and fibrinogen.ROC analysis revealed that preoperative INR >1.15 predicted bleeding with 83% sensitivity and 56% specificity(AUC = 0.72).Multivariate logistic regression including INR, weight, bowel length,presence of terminal ileum, operation durations revealed no statistically significant predictors.Clinically,higher INR and lower weight appeared associated with increased bleeding risk.Five of six bleeding patients lacked terminal ileum and ileocecal valve(p = 0.221).No significant association's found between fat-soluble vitamin deficiencies and bleeding.One patient required reoperation due to uncontrolled hemorrhage, while others 're managed medically.

Conclusion:

Postoperative bleeding may occur in SBS patients despite normal coagulation tests.Standard tests may not be sufficient alone.Further studies are warranted to clarify underlying mechanisms and improve risk prediction.