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Revisión exhaustiva sobre el manejo actual de la hemorragia del intestino inferior
Shivaraj Afzalpurkar1, Uday C Ghoshal2, Mahesh Kumar Goenka3
1Nanjappa Multi-Speciality Hospitals, Davangere, 577 005, India.
Resumen
El sangrado gastrointestinal inferior (SGII) es común, con causas variadas a nivel mundial. La colonoscopia es la principal herramienta diagnóstica y terapéutica para pacientes estables, mientras que la angiotomografía computarizada ayuda en casos inestables.
Área de la Ciencia:
- Gastroenterología
- Endoscopia
- Diagnóstico Médico
Sus antecedentes:
- La definición de hemorragia gastrointestinal inferior (SGII) ha evolucionado, centrándose ahora en fuentes colónicas o colorrectales.
- La incidencia global de SGII es de 20.5-87.0 por 100,000 personas-año, con una mortalidad del 2.5-3.9% y tasas de resangrado del 13-19%.
- Las etiologías varían a nivel mundial: sangrado por divertículos en Occidente, colitis y hemorroides en la India.
Objetivo del estudio:
- Revisar los enfoques diagnósticos y terapéuticos de la hemorragia gastrointestinal inferior aguda.
- Destacar el papel de la colonoscopia y la angiotomografía computarizada en el manejo del SGII.
- Enfatizar un enfoque multidisciplinario para pacientes de alto riesgo.
Principales métodos:
- Revisión de la literatura actual sobre el diagnóstico y manejo de la hemorragia gastrointestinal inferior.
- Énfasis en la colonoscopia como modalidad diagnóstica y terapéutica inicial para pacientes hemodinámicamente estables.
- Discusión de la angiotomografía computarizada (angioTC) para pacientes inestables o cuando la colonoscopia falla.
Principales resultados:
- La colonoscopia es eficaz para el diagnóstico y la hemostasia utilizando técnicas como la aplicación de clips y la coagulación térmica.
- La angiotomografía computarizada es crucial para pacientes inestables y casos en los que la hemostasia endoscópica no tiene éxito.
- El manejo requiere una cuidadosa consideración de la estabilidad del paciente y las comorbilidades, incluido el uso de anticoagulantes.
Conclusiones:
- La colonoscopia es la piedra angular para diagnosticar y tratar el SGII agudo en pacientes estables.
- La angiotomografía computarizada es vital para pacientes hemodinámicamente inestables y sangrado refractario.
- Un enfoque multidisciplinario es esencial para el manejo del SGII, particularmente en pacientes con anticoagulantes o con stent coronario reciente.
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