Impact of modern diagnostic methods on the management of active rectal bleeding. Ten year experience

We analyzed 178 patients admitted with a diagnosis of lower gastrointestinal hemorrhage from 1970 to 1979. Fifty-four percent had a subsequent or previous episode of bleeding and 78 percent required transfusions. One hundred eighteen patients had rigid sigmoidoscopy, with positive findings in 10 (8.5 percent); 98 underwent angiography, with positive findings in 41 percent; and 58 underwent colonoscopy, with positive findings in 48 percent. Comparison of these tests when the patient had active bleeding revealed the rates of positive findings for angiography and colonoscopy to be 42 and 85 percent, respectively. Sixty-five patients underwent operation and 16 eventually died, for a mortality rate of 25 percent. There was a higher percentage of deaths among patients with nondirected than in those with directed operations (32 versus 22 percent). Patients with lower gastrointestinal bleeding should undergo aggressive diagnostic evaluation utilizing sigmoidoscopy, angiography, and colonoscopy to increase the number of directed operations and decrease mortality and operative morbidity.