Acute Lower Gastrointestinal Bleed: Review of Clinical Course and Outcome in Hospitalized Patients

Abstract

Methods: Consecutive patients admitted with ALGIB were reviewed. Data collected comprised age, gender, prior episodes of ALGIB, co-morbid illness, vital signs, blood transfusion requirements, timing of colonoscopy and/or findings at surgery and outcomes. Results: There were 189 patients reviewed with a mean age of 67 years. There was a predominance of females (55% vs 45%) with 80% of patients having at least one co-morbid illness. The use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) was present in 24% and 16% of patients, respectively. A previous diagnosis of diverticular disease was found in 31%. Colonoscopy was performed in 72% of patients with a median time of four days to the procedure. Overall, 19% of patients required emergency surgery with no deaths. The leading causes of ALGIB were diverticular disease 56%, colorectal cancer and haemorrhoidal disease 11% each and colonic polyps 8.5%. Recurrent bleeding occurred in 3.7% and blood transfusion was given in 43%. The average hospitalization stay was seven days, eight days for patients 65 years or older. Overall mortality was 2.6%. Conclusion:Acute lower gastrointestinal bleed occurred most frequently in the elderly population with the majority afflicted with co-morbid illnesses. Diverticular disease was the most common cause. Overall mortality (2.6%) was low and emergency surgery is associated with low mortality. Older patients had a longer hospital stay.