Lower gastrointestinal bleeding surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
Emergency surgery may be needed to control bleeding in about 10% to 25% of patients in whom nonoperative management is unsuccessful or unavailable. | Emergency surgery may be needed to control bleeding in about 10% to 25% of patients in whom nonoperative management is unsuccessful or unavailable.<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=}}</re | ||
===Indications=== | ===Indications=== | ||
Indications for emergent surgery include: | Indications for emergent surgery include: | ||
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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
Emergency surgery may be needed to control bleeding in about 10% to 25% of patients in whom nonoperative management is unsuccessful or unavailable.
Surgery
Emergency surgery may be needed to control bleeding in about 10% to 25% of patients in whom nonoperative management is unsuccessful or unavailable.[1][2][3]<ref name="pmid23018607">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.</re
Indications
Indications for emergent surgery include:
- Hemodynamic instability with active bleeding
- Recurrent bleeding
- Transfusion requirement of greater than 6 units of packed red blood cells (PRBCs) in 24 hours with active bleeding.
- Patients requiring ten or more units of PRBCs in 24 hours have a significantly greater mortality than patients who receive less than 10 units of blood (45% vs 7%).
Surgical Options
- Surgical options include segmental resection and subtotal colectomy.
- If emergency surgery is required, definitive localization of the bleeding site is ideal, because segmental colonic resection is preferred.
- However, segmental resection should be avoided unless the source is definitely identified because this operation is associated with high rebleeding, morbidity, and mortality rates.
- If the bleed cannot be localized, a subtotal colectomy is the recommended procedure.
- Bleeding caused by tumors should be resected with the appropriate oncologic procedure to ensure adequate margins and lymph nodes in the specimen.
- Intraoperative proctoscopy may help to exclude bleeding from a rectal source in patients undergoing subtotal colectomy
Complications
- Both emergency segmental resection and subtotal colectomy are associated with high morbidity and mortality and should, therefore, be considered as a final treatment option
- 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.