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Impact of emergency angiography in massive lower gastrointestinal bleeding
Insights
Emergency angiography aids in locating lower gastrointestinal bleeding sites, enabling targeted segmental colectomy. Vasopressin infusion offers temporary control, facilitating elective surgery and reducing operative morbidity.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Colorectal Surgery
Background:
- Massive lower gastrointestinal bleeding (MLGIB) presents a significant clinical challenge.
- Traditional management often involves emergency surgery with high morbidity.
- Identifying the bleeding source is crucial for effective treatment.
Purpose of the Study:
- To evaluate the efficacy of emergency angiography in managing MLGIB.
- To assess the role of vasopressin infusion in controlling bleeding and enabling elective surgery.
- To compare the outcomes of angiography-guided segmental colectomy with historical data of emergency subtotal colectomy.
Main Methods:
- Fifty patients with MLGIB were managed with emergency angiography.
- Selective intra-arterial vasopressin infusion was administered to 22 patients.
- Surgical outcomes, including morbidity and rebleeding rates, were analyzed.
Main Results:
- Angiography successfully located bleeding sites in 72% of patients, distributed throughout the colon.
- Vasopressin infusion stopped bleeding in 91% of treated patients, though 50% rebled upon cessation.
- Thirty-five patients underwent surgery, with 57% elected after vasopressin therapy, showing significantly improved operative morbidity (8.6%) compared to emergency subtotal colectomy (37%).
- Seventeen patients had segmental colectomy with no rebleeding.
Conclusions:
- Emergency angiography is effective in locating bleeding sites in MLGIB.
- Vasopressin infusion can transiently control bleeding, facilitating elective segmental colectomy.
- This approach significantly reduces operative morbidity and rebleeding rates compared to emergency subtotal colectomy.
Abstract:
Fifty patients with massive lower gastrointestinal bleeding were initially managed with emergency angiography. The average age was 67.2; mean hematocrit, 23.7; and average transfusion, 7.6 units. Thirty-six patients (72%) had bleeding site located; bleeding sites were distributed throughout the colon. Etiologies of bleeding included diverticular disease (19 patients) and arteriovenous malformations (15 patients). Twenty of 22 (91%) patients receiving selective intra-arterial vasopressin stopped bleeding; however, 50% rebled on cessation of vasopressin. Thirty-five of 50 (70%) patients underwent surgery, with 57% operated on electively after vasopressin therapy. Seventeen patients had segmental colectomy, with no rebleeding. Nine of the 17 patients had diverticular disease in the remaining colon. Operative morbidity in these 35 patients was significantly improved when compared to previously reported patients undergoing emergency subtotal colectomy without angiography (8.6% vs. 37%) (p less than 0.02). Emergency angiography successfully locates the bleeding site, allowing for segmental colectomy. Vasopressin infusion transiently halts bleeding, permitting elective surgery in many instances.