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home - Miscellaneous - Bleeding - Lower GI Bleeding Written by Dr Sebastian Zeki

Lower GI Bleeding

Transcatheter embolization may be a more definitive means of controlling hemorrhage, but is associated with a risk of intestinal infarction that may reach 20% Operative intervention and is necessary in 18 to 25 % of patients who require transfusion.Preoperative localization of the site of bleeding and use of vasopressin as a temporizing measure has reduced the operative morbidity from segmental colectomy to from 37% to 8.6% after emergency subtotal colectomy.Surgical mortality is approximately 10 %, a reflection of comorbid conditions.Exploratory laparotomy is considered to be the final diagnostic modality; a source is identified in 78 % of patients without a preoperative diagnosis.Intraoperative colonoscopy may assist in diagnosis and localization.Segmental colectomy is performed when the source of bleeding has been localized; the rate of rebleeding is 0 to 14 % .A segmental resection eradicating the bleeding site is adequate in patients with extensive diverticular disease. There is no need to remove all the diverticula.Subtotal colectomy is reserved for the patient who continues to bleed without a documented site of bleeding. It is associated with high morbidity (1/3rd) and mortality rates (1/3rd). However, the rebleeding rate is virtually nil. Approach to Diverticular Bleed and Lower GI bleeds in general Surgical intervention — Yes Small bowel studies Yes No OGD Possible upper GI source History and examination +ve: Treat as necessary Arteriography (+/- nuclear scan first)Surical consulatation Has haematochaezia stopped Not possible due to severity of bleeding Negative exam Source identified: Treat as appropriate Colonoscopy Negative

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