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The management of massive lower gastrointestinal bleeding
B M Parkes1, F N Obeid, V J Sorensen
1Department of Surgery, Henry Ford Hospital, Detroit, Michigan.
The American Surgeon
|October 1, 1993
Summary
Subtotal colectomy is best for massive lower gastrointestinal bleeding when the bleeding source isn't found. Segmental colectomy is effective if angiography identifies the bleeding site, reducing re-bleeding and complications.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Colorectal Surgery
Background:
- Massive lower gastrointestinal bleeding (LGIB) presents significant management challenges.
- Surgical intervention is often necessary for hemodynamically unstable patients or those requiring transfusions.
Purpose of the Study:
- To determine the most effective surgical treatment for massive LGIB.
- Compare outcomes of segmental colectomy versus subtotal colectomy.
Main Methods:
- Retrospective review of 31 patients undergoing colon resection for massive LGIB.
- Analysis of re-bleeding rates, complication rates, and mortality based on surgical approach (segmental vs. subtotal colectomy) and angiographic findings.
Main Results:
- Subtotal colectomy had a 0% re-bleeding rate.
- Segmental resection with positive angiography had a 14% re-bleeding rate.
- Segmental resection with negative angiography had a 42% re-bleeding rate, with the highest complication (83%) and mortality (57%) rates.
Conclusions:
- Segmental colectomy is recommended when the bleeding site is identified via angiography.
- Subtotal colectomy should be reserved for cases of massive LGIB with negative angiography.