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Major lower intestinal haemorrhage. Angiographic localisation and current management
M M Parry1, J E Krige, E P Harries-Jones
1Department of Surgery, University of Cape Town, Observatory, RSA.
Summary
Selective mesenteric angiography aids in identifying major lower intestinal bleeding sources like diverticulosis and angiodysplasia. While radiological control is unreliable, angiography guides surgical strategy for better hemorrhage management.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Oncology
Background:
- Major lower intestinal bleeding is a significant clinical challenge.
- Accurate localization of bleeding sources is crucial for effective management.
- Diverticulosis and angiodysplasia are common etiologies of colonic hemorrhage.
Purpose of the Study:
- To evaluate the efficacy of selective mesenteric angiography in diagnosing and managing major lower intestinal bleeding.
- To determine the common sources and locations of colonic bleeding.
- To assess the role of angiography in guiding surgical interventions.
Main Methods:
- Retrospective analysis of 34 patients with major lower intestinal bleeding.
- Emergency selective mesenteric angiography performed over a 6-year period.
- Correlation of angiographic findings with surgical and clinical outcomes.
Main Results:
- Angiography identified a bleeding site in 47% of patients.
- Diverticulosis (65%) and angiodysplasia (12%) were the most frequent causes, often originating from the right colon.
- Radiological control was unreliable; surgery was required in most patients with positive angiograms.
- Angiographic localization facilitated limited resection in 89% of cases.
- Overall mortality was 29%, with higher rates in operative (40%) versus non-operative (14%) management.
Conclusions:
- Selective mesenteric angiography is valuable for identifying bleeding sources in major lower intestinal bleeding.
- Angiography aids in surgical planning, enabling limited resections.
- Despite limitations in radiological control, angiography improves the management strategy for colonic hemorrhage.