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 to initial medical and supportive therapy. | |||
==Surgery== | ==Surgery== | ||
===Indications=== | ===Indications=== | ||
*Hemodynamic instability with active bleeding | *Hemodynamic instability with active bleeding | ||
*Recurrent bleeding | *Recurrent bleeding after initial resusucation | ||
*Transfusion requirement of greater than 6 units of packed red blood cells (PRBCs) in 24 hours with active 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 | **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. | ||
===Surgical Options=== | ===Surgical Options=== | ||
*Surgical options include segmental resection and subtotal colectomy. | *Surgical options include segmental resection and subtotal colectomy. | ||
Revision as of 01:41, 4 January 2018
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Lower gastrointestinal bleeding Microchapters |
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Differentiating Lower gastrointestinal bleeding from other Diseases |
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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 to initial medical and supportive therapy.
Surgery
Indications
- Hemodynamic instability with active bleeding
- Recurrent bleeding after initial resusucation
- 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.
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%.