Massive Bleeding of Colonic Origin

Abstract

Acute gastrointestinal bleeding remains a common cause of hospitalization despite advances in diagnosis and therapy. Patient morbidity and mortality in gastrointestinal hemorrhage frequently are related to the underlying illness rather than the bleeding itself.52 It is important that the patient is managed appropriately in the setting of an acute bleeding episode. Adequate treatment depends on assessing of hemodynamic stability accurately, determining the rate of active bleeding, and identifying the bleeding source. Hemodynamic stability is determined by measuring orthostatic blood pressure and the rate of resting tachycardia. Adequate intravenous access and rapid intravascular volume replacement are essential in correcting or avoiding further hemodynamic compromise. Fluid administration and red blood cell replacement as well as correction of any coagulopathy present with platelets or fresh-frozen plasma are the mainstay of immediate care. Large-volume hematemesis and hematochezia (bright red blood per rectum) are more obvious indicators of active bleeding, but the degree of bleeding often is less evident.103 Nasogastric aspiration may be helpful in patients without hematemesis, but it is limited by its lack of specificity and sensitivity. Once the aforementioned issues have been addressed, further assessment of the bleeding source can be determined endoscopically or radiographically. Acute upper gastrointestinal, small bowel, and lower gastrointestinal bleeding have various clinical presentations and therapies that need to be recognized.