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Segmental colectomy for bleeding diverticular disease guided by the PEEP test.

Vijay Naraynsingh1, Shamir O Cawich1, Dale Hassranah1

  • 1Consultant Surgeon, Department of Clinical Surgical Sciences, St Augustine Campus, University of the West Indies, St. Augustine, Trinidad & Tobago.

Tropical Doctor
|August 3, 2017
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Summary

The positive endoluminal erythrocyte presence (PEEP) test accurately guides segmental colectomy for lower gastrointestinal bleeding from diverticulosis. This method successfully controlled bleeding in 93% of emergency surgery patients, avoiding unnecessary total colectomies.

Keywords:
Colectomybleedingemergencygastrointestinalsegmentaltotal

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Medical Diagnostics

Background:

  • Massive lower gastrointestinal (GI) hemorrhage from diverticulosis often leads to total colectomy due to unavailable preoperative localization.
  • Limited retrograde reflux observed in colectomy specimens suggests a potential for more targeted surgical approaches.
  • Current diagnostic limitations necessitate exploration of novel methods for precise bleeding source identification.

Purpose of the Study:

  • To evaluate the efficacy of the positive endoluminal erythrocyte presence (PEEP) test in directing segmental colectomies for massive lower GI hemorrhage.
  • To determine if the PEEP test can improve outcomes compared to blind total colectomy in emergency settings.
  • To assess the PEEP test's utility in localizing the source of diverticular bleeding during emergency surgery.

Main Methods:

  • A prospective study involving 14 patients undergoing emergency surgery for massive lower GI hemorrhage.
  • The positive endoluminal erythrocyte presence (PEEP) test was employed to detect fresh blood in the caecum, guiding surgical resection.
  • Segmental colectomy was performed based on PEEP test results in the absence of conventional preoperative localization.

Main Results:

  • The PEEP test successfully guided segmental colectomy in 13 out of 14 patients (93%), achieving effective bleeding control.
  • No mortality was observed; postoperative morbidity was 14% following PEEP-guided segmental resections.
  • One patient required completion colectomy due to persistent bleeding on postoperative day three.

Conclusions:

  • The PEEP test is a valuable tool for guiding segmental resection in patients with massive lower GI hemorrhage from diverticulosis when conventional localization fails.
  • PEEP-guided segmental colectomy offers a successful alternative to total colectomy, improving patient outcomes and reducing surgical scope.
  • Blind total colectomy is recommended if the PEEP test is equivocal, with early completion colectomy considered for significant re-bleeding.