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[Massive lower digestive bleeding]

A Celestino1

  • 1Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú.

Revista De Gastroenterologia Del Peru : Organo Oficial De La Sociedad De Gastroenterologia Del Peru
|January 1, 1995
PubMed
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Lower digestive bleeding, often acute, requires immediate shock treatment. Diagnosis involves clinical history, endoscopy, and imaging, with therapies including endoscopic, angiographic, or surgical interventions.

Area of Science:

  • Gastroenterology
  • Internal Medicine
  • Emergency Medicine

Background:

  • Lower digestive bleeding (LDB) is defined as hemorrhage distal to the ligament of Treitz.
  • Acute and massive LDB constitutes approximately 20% of all acute gastrointestinal bleeding cases.
  • Etiologies vary by age, including juvenile polyps and Meckel's diverticula in younger patients, and diverticular disease, angiodysplasia, and neoplasia in adults.

Purpose of the Study:

  • To outline the diagnostic and therapeutic strategies for acute lower digestive bleeding.
  • To highlight the common causes of LDB across different age groups.
  • To emphasize the critical initial management of hypovolemic shock.

Main Methods:

  • Initial management focuses on hemodynamic stabilization and treatment of hypovolemic shock.

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  • Diagnostic approaches include clinical history, physical examination, proctosigmoidoscopy, emergency colonoscopy, angiography, and scintigraphy with 99mTc-labeled red blood cells.
  • Therapeutic options encompass endoscopic interventions, angiographic procedures, and emergency surgery.

    • Main Results:

    • Prompt resuscitation is paramount for patients with acute massive LDB.
    • A systematic diagnostic workup is essential to identify the bleeding source.
    • Treatment strategies are tailored to the underlying cause and patient stability.

    Conclusions:

    • Effective management of acute LDB necessitates a rapid, multidisciplinary approach.
    • Timely diagnosis and intervention significantly impact patient outcomes.
    • Mortality rates for acute LDB range from 11% to 21%.