Scientific Papers
Total colectomy versus limited colonic resection for acute lower gastrointestinal bleeding

Presented at the 51st Annual Meeting of the Southwestern Surgical Congress, Coronado, California, April 18–21, 1999.
https://doi.org/10.1016/S0002-9610(99)00235-4Get rights and content

Abstract

Background: Acute lower gastrointestinal bleeding (ALGB) of the colon can be problematic to diagnose. The purpose of this study was to review our experience with ALGBs and to determine any differences between limited colon resection (LCR) and total/subtotal colon resection (TCR).

Methods: A retrospective study located 77 patients with ALGB, who required 2 or more units of packed red blood cells prior to surgery, and who were taken to the operating room from 1987 to 1997.

Results: Fifty LCRs and 27 TCRs were performed during this 10-year period. Recurrent bleeding was significantly more common in the LCR group than in the TCR group (18% versus 4%). Morbidity and mortality were not significantly different.

Conclusions: Owing to the misconception of a higher morbidity with TCR, it has been considered a “last resort” instead of a more expeditious therapy with similar morbidities and mortalities. TCR should be considered more often in the management of these patients.

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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