Lower gastrointestinal bleeding surgery

Lower gastrointestinal bleeding Microchapters
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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
• 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%.