Urgent Colonoscopy for the Diagnosis and Treatment of Severe Lower GI Bleeding and Acute Colorectal Obstruction

Abstract

Background and Aim: Although urgent colonoscopy is often used to diagnose and treat severe lower gastrointestinal (GI) bleeding, its role in the management of acute colorectal obstruction is uncertain. Regardless of the site of colorectal obstruction, the development of a new device and techniques for its use have made it possible to endoscopically decompress acute colorectal obstruction (GI Endoscopy 2001;54:229-32). The aim of this study was to clarify the role of urgent colonoscopy in the diagnosis and treatment of acute colorectal obstruction in addition to severe lower GI bleeding. Method: From January 2001 to November 2004, 106 patients (64 males and 42 females, age 46 to 94, mean = 68.7) were identified in a colorectal database, and their cases were reviewed. All patients were hospitalized because of severe hematochezia or acute colorectal obstruction based upon abdominal CT findings. Urgent colonoscopy was performed within 24 hours for the purpose of the definite diagnosis of active lower GI bleeding or acute colorectal obstruction. After the diagnosis was confirmed, endoscopic hemoclip placement or endoscopic decompression using a transanal drainage tube was attempted. Results: In 49 (92.5%) of 53 patients who had severe lower GI bleeding, endoscopic hemoclip placement was successful. The etiology of lower GI bleeding was post-polypectomy bleeding (17), diverticulosis (14), postoperative bleeding (8), anorectal bleeding (5) or other (5). In 4 patients, bleeding sources were not identified. Endoscopic decompression by means of a transanal drainage tube was technically successful in 50 of 53 patients (94.3%). Two patients had colonic perforation. The site of obstruction was cecum in 3, ascending colon in 4, transverse colon in 5, descending colon in 11, sigmoid colon in 18, and rectum in 12. Following adequate cleansing of the colon, 42 patients underwent surgery after 7 days ± 3.2 (SD; range, 4-10 days). Stent placement was used as final palliative treatment in 4 patients. Conclusions: Urgent colonoscopy is very useful for the treatment and management of acute colorectal obstruction as well as severe lower GI bleeding. Since endoscopic decompression using a transanal drainage tube seems to be effective, acute colorectal obstruction should be considered as another indication for urgent colonoscopy to prevent emergency surgery in addition to severe lower GI bleeding. Background and Aim: Although urgent colonoscopy is often used to diagnose and treat severe lower gastrointestinal (GI) bleeding, its role in the management of acute colorectal obstruction is uncertain. Regardless of the site of colorectal obstruction, the development of a new device and techniques for its use have made it possible to endoscopically decompress acute colorectal obstruction (GI Endoscopy 2001;54:229-32). The aim of this study was to clarify the role of urgent colonoscopy in the diagnosis and treatment of acute colorectal obstruction in addition to severe lower GI bleeding. Method: From January 2001 to November 2004, 106 patients (64 males and 42 females, age 46 to 94, mean = 68.7) were identified in a colorectal database, and their cases were reviewed. All patients were hospitalized because of severe hematochezia or acute colorectal obstruction based upon abdominal CT findings. Urgent colonoscopy was performed within 24 hours for the purpose of the definite diagnosis of active lower GI bleeding or acute colorectal obstruction. After the diagnosis was confirmed, endoscopic hemoclip placement or endoscopic decompression using a transanal drainage tube was attempted. Results: In 49 (92.5%) of 53 patients who had severe lower GI bleeding, endoscopic hemoclip placement was successful. The etiology of lower GI bleeding was post-polypectomy bleeding (17), diverticulosis (14), postoperative bleeding (8), anorectal bleeding (5) or other (5). In 4 patients, bleeding sources were not identified. Endoscopic decompression by means of a transanal drainage tube was technically successful in 50 of 53 patients (94.3%). Two patients had colonic perforation. The site of obstruction was cecum in 3, ascending colon in 4, transverse colon in 5, descending colon in 11, sigmoid colon in 18, and rectum in 12. Following adequate cleansing of the colon, 42 patients underwent surgery after 7 days ± 3.2 (SD; range, 4-10 days). Stent placement was used as final palliative treatment in 4 patients. Conclusions: Urgent colonoscopy is very useful for the treatment and management of acute colorectal obstruction as well as severe lower GI bleeding. Since endoscopic decompression using a transanal drainage tube seems to be effective, acute colorectal obstruction should be considered as another indication for urgent colonoscopy to prevent emergency surgery in addition to severe lower GI bleeding.