Evaluation and Management of Massive Lower Gastrointestinal Hemorrhage

Abstract

Sixty-eight patients with massive lower gastrointestinal (G.I.) hemorrhage underwent emergency arteriography. Patients were transfused an average of six units of packed red blood cells within 24 hours of admission. The bleeding source was localized arteriographically in 27 (40%), with a sensitivity of 65% among patients requiring emergency resection. However, twelve of the 41 patients with a negative arteriogram still required emergency intestinal resection for continued hemorrhage. Radionuclide bleeding scans had a sensitivity of 86%. The right colon was the most common site of bleeding (35%). Diverticulosis and arteriovenous malformation were the most common etiologies. Selective intra-arterial infusion of vasopressin and embolization were successful in 36% of cases in which they were employed and contributed to fatality in two patients. Twenty-three patients underwent segmental resection, whereas seven patients required subtotal colectomy for multiple bleeding sites or negative studies in the face continued hemorrhage. Intraoperative infusion of methylene blue via angiographic catheters allowed successful localization and resection of bleeding small bowel segments in three patients. Overall mortality was 21%. The mortality for patients without a malignancy, with a positive preoperative arteriogram, and emergency segmental resection was 13%.

Lower gastrointestinal bleeding as a result of fistula between the iliac artery and sigmoid colon in patient with advanced testicular cancer

“…The time between the first bleeding of an aorto-enteric fistulae, called sentinel, and the massive bleeding usually takes hours or even months, but the correct diagnosis during the first bleeding improves prognosis (4). Although arteriography presents less sensitivity than scintigraphy to localize the source of intestinal bleeding, a positive exam is able to predict which patients will need surgical treatment (1). During massive intestinal bleeding, the identification of the localization of the bleeding using arteriography allows segmental intestinal resection, and better outcome (1).…”

“…Although arteriography presents less sensitivity than scintigraphy to localize the source of intestinal bleeding, a positive exam is able to predict which patients will need surgical treatment (1). During massive intestinal bleeding, the identification of the localization of the bleeding using arteriography allows segmental intestinal resection, and better outcome (1). In the present report, the massive intestinal bleeding with hemodynamic alteration lead us to perform an initial and precocious angiography, that correctly identified the source and place of bleeding, allowing an efficient surgical treatment.…”

“…Main causes of massive lower gastrointestinal bleeding include colon diverticular disease and vascular malformations (1). Right colon is most frequently the involved organ in bleeding and diagnosis is often performed using endoscopic and image exams (1).…”

“…Right colon is most frequently the involved organ in bleeding and diagnosis is often performed using endoscopic and image exams (1). Fistulae between arteries and gastrointestinal tract are a rare cause of gastrointestinal bleeding, and most frequently in literature include aorto-enteric fistulae (2,3) secondary to aorta surgeries, with communication between proximal anastomosis and duodenum (2,3).…”

Treatment of gastrointestinal hemorrhage

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