Impact of Emergency Angiography in Massive Lower Gastrointestinal Bleeding

Browder, William; Cerise, Elmo J.; Litwin, Martin S.

doi:10.1097/00000658-198611000-00004

Cited by 253 publications

(123 citation statements)

References 17 publications

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“…In one investigation by Browder et al [16] , a massive lower GI bleed was defined by a systolic blood pressure of less than 100 mmHg while bleeding, and a minimum requirement of 4 units of blood transfused in 2 h. The study resulted in a 72% yield (positive angiogram in 36/50 patients) and showed that in patients who were Rasuli P et al . Factors influencing the yield of mesenteric angiography grams turn out to be negative due to lack of active bleeding and wrong timing.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

Rasuli¹

2014

WJR

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AIM:To assess if certain triaging rules could be estab lished to optimize the yield of mesenteric angiography. METHODS:Medical records of 101 patients were ret rospectively reviewed and parameters relating to age, gender, pulse rate, blood pressure, serum hemoglobin, intensive care unit (ICU) admission, and the number of packed red blood cells (PRBC) transfused in the 12 and 24 h prior to the angiography were tabulated in two groups with positive and negative angiography results. RESULTS:We found no correlation between gender, pulse rate, blood pressure or serum hemoglobin and positivity of the mesenteric angiogram. But patients with positive angiogram were found to be on average 7 years older (73.2 years vs 65.9 years old) (P = 0.02).Angiogram was positive in 39.3 % (11/28) of patients admitted in ICU vs 23.2% (17/73) who were admitted elsewhere in the hospital (P = 0.03). In the 12 and 24 h prior to angiography, patients with a positive angio gram received a mean of 2.7 ± 2.3 and 3.3 ± 2.6 units of PRBC s respectively, while patients with a negative angiogram had a mean of 1.6 ± 1.9 (P = 0.02) and 2.1 ± 2.6 units (P = 0.04) received respectively in the same period. CONCLUSION:Older age, ICU admission, having re ceived at least 4 units PRBC over 12 h or 5 units over 24 h prior to angiogram are leading indicators for a positive study.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Angiography; Diagnostic use; Colon; Blood supply; Radiograph; Gastrointestinal hemorrhage; Emer gencies; Mesenteric arteries Core tip: Mesenteric angiography is associated with a low yield of about 30%. We evaluated several factors in 101 patients undergoing mesenteric angiography in a tertiary care institution to see if any could be used for predicting a positive angiogram. We found that vital signs are poor discriminators but older age, intensive care unit admission, having received at least 4 units PRBC over 12 h or 5 units over 24 h prior to angiogram are leading indicators for a positive study. We postulate that the reason is that patients are given enough blood units to compensate for blood loss and stabilize vital signs and therefore the number of blood units given indirectly correlate with severity of active bleeding.Rasuli P, Doumit J, Boulos M, Rizk C, Doumit G. Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed. World J Radiol 2014; 6(5): 218-222 Available from:

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Section: Discussionmentioning

confidence: 99%

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

Rasuli¹

2014

WJR

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“…The celiac artery (CA) can also be a source of hemorrhage [8]. Lower intestinal bleeding that arises from the branches of the internal iliac artery (IIA) is very rare, and we typically see this kind of hemorrhage in patients who have advanced pelvic malignancies.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Embolization for the Treatment of Both Vaginal and Lower Intestinal Bleeding Due to Advanced Pelvic Malignancy

Karaman¹,

Ören²,

Andıç³

et al. 2010

EAJM

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We report a 31-year-old woman with end-stage cervical carcinoma who suff ers both lower intestinal and vaginal bleeding. A selective internal iliac arteriogram demonstrated pseudoaneurysm formation in the vaginal branch of the left internal iliac artery. There was also a fi stula between the pseudoaneurysm and the lower intestinal segments. Selective transcatheter coil embolization was performed, and the bleeding was treated successfully. We conclude that the internal iliac artery should be evaluated fi rst in patients with advanced pelvic malignancy when searching for the source of lower gastrointestinal (GI) bleeding. Additionally, transcatheter arterial embolization is a safe and eff ective treatment technique.Key Words: Angiography, Coil embolization, Hemorrhage, Lower gastrointestinal bleeding, Transcatheter ÖzetEş zamanlı vajinal ve alt intestinal kanamalı son dönem servikal kanseri bulunan 31 yaşındaki kadın hastanın transkateter koil embolizasyonunu sunuyoruz. Hastanın selektif iliak arteriogramında sol internal iliak arterinin vajinal dalında yalancı bir anevrizma formasyonu ve yalancı anevrizma ile alt intestinal segmentlerde fistül traktı gözlenmesi üzerine anjiografik girişim planlandı. Selektif koil embolizasyonu ile kanama başarılı olarak tedavi edildi.Olgudan çı-kardığımız sonuç ileri evre pelvik malignitesi olan hastalardaki alt intestinal kanamalarda öncelikle internal iliak arter çalışılmalıdır. Embolizasyon tedavileri de gelişen teknoloji ile birlikte oldukça başarılı hale gelmiştir.

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“… Intravascular vasopressin infusion may be used as a temporising measure  If the patient subsequently needs surgery, segmental resection guided by pre-operative angiography results in significantly lower morbidity than in historic controls without localisation (Browder 1986;Drapanas 1973;Klas 1997;Nath 1981). This approach is also associated with lower rebleeding rates at one year (Parkes 1993).…”

Section: Angiography and Angioembolisationmentioning

confidence: 99%

Practical Issues in the Decision Making and Management of Acute lower Gastrointestinal Bleeding: An Algorithmic Approach

2017

International Journal of Research Studies in Medical and Health

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ABSTRACT:Acute lower Gastro intestinal bleeding is a relatively common problem in the emergency department. Etiology is diverse as is the degree of bleeding and natural history. Hence there are a number of subtle aspects of clinical assessment, investigations and management which require attention and application fr optimal outcomes. The goal of this review is to highlight the practical issues in managing the condition from the perspective of a medical officer or a junior resident in surgery who is on-call in the emergency department. A working algorithm incorporating the key management issues is also presented.

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Impact of Emergency Angiography in Massive Lower Gastrointestinal Bleeding

Cited by 253 publications

References 17 publications

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

Transcatheter Embolization for the Treatment of Both Vaginal and Lower Intestinal Bleeding Due to Advanced Pelvic Malignancy

Practical Issues in the Decision Making and Management of Acute lower Gastrointestinal Bleeding: An Algorithmic Approach

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