[100 consecutive patients with lower gastrointestinal bleeding: causes of incorrect diagnoses, recurrent bleeding and...

A standard approach involving sequential investigations made it possible to identify a bleeding source in 98 out of 100 patients with massive lower gastrointestinal bleeding. In 5 cases the preoperative diagnosis was incorrect. Only in 2 patients was no pathology detectable. Recurrent bleeding occurred in 8 patients, 5 of whom subsequently died of hemorrhagic shock. The overall mortality was 10%, or 11% if a patient with late death due to massive rebleeding was included. 8 complications or deaths were due to diagnostic (n = 3) and therapeutic (n = 5) errors. The remaining complications with fatal outcome (n = 6) were due to the patient's associated or underlying disease. We conclude that in patients with angiographically visualized arteriovenous malformations in the coecum, a second lesion needs to be ruled out. To prevent some complications a more aggressive therapeutic approach seems necessary. On the other hand, there remain complications and deaths that cannot be prevented in view of the advanced stage of the associated or underlying disease.