Optimal timing of anticoagulation pre- and post-colonoscopy with polypectomy.

Purpose: An increasing number of patients are treated with anticoagulation for many medical conditions. Our practice is to suspend warfarin 5-7 days, aspirin 3 days, and clopidogrel (Plavix) 7 days prior to colonoscopy that may require polypectomy. Generally, we accept an INR of ≤1.

Simplified management of low-energy projectile extraperitoneal rectal injuries.

Introduction: Since minimally invasive approach for fecal diversion in low-velocity extraperitoneal rectal injuries (EPRI) has a lower morbidity than open, and since computed tomography (CT) scan is helpful in ruling out concomitant intraperitoneal injuries (IPI), we utilized both modalities to simplify management of such injuries.

Methods: Retrospective review of stable patients with EPRI, treated with laparoscopic assisted diversion, after a CT scan, compared with patients with similar injuries that had a negative laparotomy and a colostomy.

Results: The laparoscopy group had a shorter length of stay (3 +/- 2 days versus 7 +/- 2 days), earlier return of bowel function (3 +/- 2 days versus 5 +/- 2 days) and fewer infectious complications.