Lower gastrointestinal bleeding surgery: Difference between revisions
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{{CMG}} ; {{AE}} {{ADG}} | {{CMG}} ; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
Surgery is not usually recommended in the management of lower gastrointestinal bleeding as most of the time bleeding is self limited. However, surgery may be required to control bleeding in about small number of patients who failed | Surgery is not usually recommended in the management of lower gastrointestinal bleeding as most of the time [[bleeding]] is self limited. However, surgery may be required to control bleeding in about small number of patients who failed [[Lower gastrointestinal bleeding medical therapy|initial medical and supportive therapy]]. | ||
==Surgery== | ==Surgery== | ||
===Indications=== | ===Indications=== | ||
*Hemodynamic instability with active bleeding | *Hemodynamic instability with active bleeding.<ref name="pmid19919917">{{cite journal |vauthors=Lee J, Costantini TW, Coimbra R |title=Acute lower GI bleeding for the acute care surgeon: current diagnosis and management |journal=Scand J Surg |volume=98 |issue=3 |pages=135–42 |year=2009 |pmid=19919917 |doi=10.1177/145749690909800302 |url=}}</ref><ref name="pmid23737154">{{cite journal |vauthors=Ghassemi KA, Jensen DM |title=Lower GI bleeding: epidemiology and management |journal=Curr Gastroenterol Rep |volume=15 |issue=7 |pages=333 |year=2013 |pmid=23737154 |pmc=3857214 |doi=10.1007/s11894-013-0333-5 |url=}}</ref><ref name="pmid21603524">{{cite journal |vauthors=Beck DE, Margolin DA, Whitlow CB, Hammond KL |title=Evaluation and management of gastrointestinal bleeding |journal=Ochsner J |volume=7 |issue=3 |pages=107–13 |year=2007 |pmid=21603524 |pmc=3096402 |doi= |url=}}</ref><ref name="pmid23018607">{{cite journal |vauthors=Triadafilopoulos G |title=Management of lower gastrointestinal bleeding in older adults |journal=Drugs Aging |volume=29 |issue=9 |pages=707–15 |year=2012 |pmid=23018607 |doi=10.1007/s40266-012-0008-1 |url=}}</ref> | ||
*Recurrent bleeding after initial | *Recurrent bleeding after initial resuscitation | ||
*Transfusion | *Transfusion of greater than 6 units of packed red blood cells (PRBCs) in 24 hours with active bleeding. | ||
===Surgical Options=== | ===Surgical Options=== | ||
*Surgical options include segmental resection and subtotal colectomy. | *Surgical options include segmental resection and subtotal colectomy. | ||
*If | *Segmental colonic resection is the most recommend emergency surgical procedure in the management of lower gastrointestinal bleeding. | ||
*However, segmental resection should be avoided unless the source is definitely identified because this operation is associated with high | *Surgical options depends on the localization of bleeding site. | ||
*If the bleeding point is localized, a subtotal colectomy is the recommended procedure. | |||
*In cases where the bleeding site is localized segmenetal colonic resection is preferred. | |||
*Intraoperative proctoscopy may help to exclude bleeding from a rectal source in patients undergoing subtotal colectomy | *However, segmental resection should be avoided unless the source is definitely identified because this operation is associated with high re-bleeding, morbidity, and mortality rates. | ||
*Intraoperative proctoscopy may help to exclude bleeding from a rectal source in patients undergoing subtotal colectomy. | |||
===Complications=== | ===Complications=== | ||
* | *High morbidity and mortality | ||
*Subtotal colectomy is associated with the highest complication rates, with morbidity rates of 20% to 60% and mortality rates of 15% 17%. | *Subtotal colectomy is associated with the highest complication rates, with morbidity rates of 20% to 60% and mortality rates of 15% 17%. | ||
Latest revision as of 01:50, 4 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Surgery is not usually recommended in the management of lower gastrointestinal bleeding as most of the time bleeding is self limited. However, surgery may be required to control bleeding in about small number of patients who failed initial medical and supportive therapy.
Surgery
Indications
- Hemodynamic instability with active bleeding.[1][2][3][4]
- Recurrent bleeding after initial resuscitation
- Transfusion of greater than 6 units of packed red blood cells (PRBCs) in 24 hours with active bleeding.
Surgical Options
- Surgical options include segmental resection and subtotal colectomy.
- Segmental colonic resection is the most recommend emergency surgical procedure in the management of lower gastrointestinal bleeding.
- Surgical options depends on the localization of bleeding site.
- If the bleeding point is localized, a subtotal colectomy is the recommended procedure.
- In cases where the bleeding site is localized segmenetal colonic resection is preferred.
- However, segmental resection should be avoided unless the source is definitely identified because this operation is associated with high re-bleeding, morbidity, and mortality rates.
- Intraoperative proctoscopy may help to exclude bleeding from a rectal source in patients undergoing subtotal colectomy.
Complications
- High morbidity and mortality
- Subtotal colectomy is associated with the highest complication rates, with morbidity rates of 20% to 60% and mortality rates of 15% 17%.
References
- ↑ Lee J, Costantini TW, Coimbra R (2009). "Acute lower GI bleeding for the acute care surgeon: current diagnosis and management". Scand J Surg. 98 (3): 135–42. doi:10.1177/145749690909800302. PMID 19919917.
- ↑ Ghassemi KA, Jensen DM (2013). "Lower GI bleeding: epidemiology and management". Curr Gastroenterol Rep. 15 (7): 333. doi:10.1007/s11894-013-0333-5. PMC 3857214. PMID 23737154.
- ↑ Beck DE, Margolin DA, Whitlow CB, Hammond KL (2007). "Evaluation and management of gastrointestinal bleeding". Ochsner J. 7 (3): 107–13. PMC 3096402. PMID 21603524.
- ↑ Triadafilopoulos G (2012). "Management of lower gastrointestinal bleeding in older adults". Drugs Aging. 29 (9): 707–15. doi:10.1007/s40266-012-0008-1. PMID 23018607.