Scientific PapersTotal colectomy versus limited colonic resection for acute lower gastrointestinal bleeding
Section snippets
Methods
Between January 1987 and July 1997, a retrospective search was performed cross-referencing data from Baylor University Medical Center operating room registry and medical records department discharge summaries to identify patients who had an operation performed because of ALGB. The majority of patients who presented with acute lower gastrointestinal bleeding did not require surgery and were excluded. Each of the patients in the study had ongoing bleeding and had received 2 or more units of
Limited colon resection versus total colon resection
Seventy-seven patients underwent either a limited colon or subtotal/total colonic resection for acute lower gastrointestinal bleeding during the 10-year period from 1987 to 1997. Fifty LCR and 27 TCR were performed. Bleeding sources included diverticuli (55%), arteriovenous malformations (18%), neoplasm (17%); Table I. Localizing tests were performed in 71 patients and included tagged red blood cell (RBC) scan (n = 44), arteriogram (n = 31), and colonoscopy (n = 57). Thirty-seven percent of the
Comments
Treatment of acute lower gastrointestinal bleeding continues to be a controversial topic. In the age of increasingly limited surgical intervention, the resolve to perform a more complex procedure can be difficult. Preoperative localization studies are useful when a clear bleeding site is found. However, these studies are often negative or difficult to interpret. If one waits to operate only on positive scans, the patient may be exposed to an unnecessary delay before definitive therapy. It is
Conclusion
In conclusion, this retrospective study represents one of the largest series of patients undergoing laparotomy for acute lower gastrointestinal bleeding. Preoperative localization is a vital part of delineating what needs to be done to help a patient. When there is time, localization can be performed to rule out a specific bleeding source such as a bleeding ulcer or carcinoma. However, in patients with an acute bleeding episode, too much time can be taken attempting to localize the lesion
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Cited by (65)
Lower Gastrointestinal Bleeding
2018, Surgical Clinics of North AmericaCitation Excerpt :In the unstable patient with unlocalized LGIB, subtotal colectomy is the traditional empiric surgical intervention. Rebleeding risk with segmental colon resection is greater than with subtotal colectomy, although the limited evidence does not agree whether this confers increased mortality.52–55 Ileorectal anastomosis was described in most of these series, a practice avoided today in unstable patients.
Acute lower gastrointestinal bleeding
2015, Medicine (United Kingdom)Citation Excerpt :Another strategy is to clamp segments of the bowel with soft clamps in order to identify the segment that fills with blood. If the bleeding source remains unclear, a subtotal colectomy with end ileostomy is the procedure of choice.24,25 It may rarely be necessary to perform an emergency proctectomy in a patient with inflammatory bowel disease with rectal haemorrhage.
Review article: Advances in the management of lower gastrointestinal bleeding
2024, Alimentary Pharmacology and TherapeuticsEvaluation and Management of Lower GI Bleeding
2022, Diseases of the Colon and RectumNumber of hospitalizations due to colonic diverticular bleeding as a predictive factor for readmission: An exploratory study
2021, Journal of Japanese Society of Gastroenterology