Management Of Lower Gastrointestinal Bleeding Research Articles

Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis

Although limited haematochezia with the first bowel movement is frequent in patients undergoing colorectal resection, postoperative life-threatening lower gastrointestinal bleeding is very rare. The purpose of this study was to review our results in the management of this complication. We analysed the cases of patients with severe lower gastrointestinal bleeding after colorectal surgery from 2000 to 2006 in our hospital. We studied the general characteristics, diagnostic data, therapeutic management and outcome. We also reviewed the published articles regarding this issue. This complication appeared in 7 (0.5%) of 1,389 colorectal procedures in the study period. In all the patients the anastomosis was stapled. In six of the seven patients bleeding resolved with conservative treatment including endoscopy. However, one patient required surgical treatment. There was no mortality and there were no anastomotic leaks in these seven patients. Severe lower gastrointestinal bleeding after colorectal resection and stapled anastomosis is a rare complication. Only in unstable patients or failure of conservative measures is surgery indicated.

Efficacy of transarterial embolization as definitive treatment in lower gastrointestinal bleeding

Transarterial catheter embolization (TAE) is integral in the management of lower gastrointestinal bleeding (BLGIT). The efficacy of superselective embolization has reduced the need for emergent surgical resection as a treatment modality. To determine the outcomes of TAE in the management of BLGIT in terms of efficacy rates, recurrent bleeding rates and long term results without the need for surgical intervention. Patients who underwent TAE for BLGIT between September 2000 and May 2006 were analysed. Data were extracted from the records for analysis. Sixty-eight patients with a mean age of 76 years and equal gender distribution were analysed. Sixty-nine per cent presented with haematochezia, 40% with malena. Sixty-three patients had a prior RBC scan performed, all of which were positive. Colonoscopy was attempted in 18 patients of which four managed to localize the bleeding site. Embolization was performed in these patients using mainly polyvinyl alcohol particles and/or microcoils. The morbidity rate was 21%, comprising mainly fever and nonspecific abdominal pain with only four ischaemic complications and one report of colonic infarction. Early recurrent bleeding occurred in six patients. Three were treated with repeat embolization and two required surgery. There were no mortalities. After a mean follow-up of 12 months, 12 (17.6%) patients developed further episodes of BLGIT, necessitating further intervention. Transarterial catheter embolization is effective and safe in the acute management of BLGIT and reduces the need for further definitive surgery in a majority of patients.

Successful Management of Bleeding Due to Solitary Rectal Ulcer via Topical Application of Ankaferd Blood Stopper

Successful Management of Bleeding Due to Solitary Rectal Ulcer via Topical Application of Ankaferd Blood Stopper

Management of lower gastrointestinal bleeding with haemodynamic instability

A 76-year-old woman presented to our emergency department owing to torrential fresh rectal bleeding. Bloody stool had been noted for 3 days and was believed to be caused by haemorrhoids....

Multiple Stomas for Recurrent Life-Threatening Gastrointestinal Bleeding: Report of a Case

Acute lower gastrointestinal hemorrhage is an uncommon and severe symptom. The overall mortality rate ranges from 5 to 12 percent and can approach 40 percent for persistent or recurring bleedings. We report a case of a patient with severe recurrent lower bleeding in whom, despite several repeated explorations and a blind subtotal colectomy, no lesion could be found. Multiple (n = 4) leveled stomas of the small bowel with succus entericus reinfusion were required to localize and treat the cause of the bleeding. This case report is followed by a review of the literature of the management of lower gastrointestinal bleeding.

Impact of the Creation of a Bleeding Unit On the Management of Lower Gastrointestinal Bleeding

Introduction: The utility of the bleeding units has been well evaluated in upper gastrointestinal bleeding. The benefit of theses units are not well established on the management of lower gastrointestinal bleeding (LGB). Aims & Methods: Aim: To analyze the influence of the creation of a bleeding unit on the management of LGB. Design: cohort study. Setting: tertiary teaching hospital. Patients: all consecutive patients admitted with LGB during 2004 (before the bleeding unit creation -group 1-) and during 2005 (after the bleeding unit creation -group 2-).

Colonoscopy and the management of lower gastrointestinal bleeding

Colonoscopy and the management of lower gastrointestinal bleeding

Management of ischemic proctitis with severe rectal haemorrhage: A case report

Acute ischemic proctitis is a rare pathological condition. We report here a patient presented with massive rectal haemorrhage from a bleeding vessel superimposed on an underlying pathology of ischemic proctitis. This case report illustrates the difficulties in making the clinical distinction between ischemic proctitis and other pathological entities. We also discussed the beneficial role of arteriogram with embolotherapy as an effective therapeutic measure in the management of lower gastrointestinal bleeding. The literature on the subject is reviewed.

The Management of Lower Gastrointestinal Hemorrhage

Gastrointestinal hemorrhage is a common clinical problem, which accounts for approximately 1 to 2 percent of acute hospital admissions. The colon is responsible for approximately 87 to 95 percent of all cases of lower gastrointestinal bleeding, with the remaining cases arising in the small bowel. The etiology, diagnostic evaluation, management, and treatment options available for lower gastrointestinal hemorrhage were reviewed. A review of lower gastrointestinal bleeding was performed, which discussed the most common etiologies with a few rare and unusual causes. The current literature about different diagnostic techniques, management problems, and therapeutic options was reviewed. Current management strategies and treatment options for the many causes of lower gastrointestinal bleeding will be reviewed. A review of the different causes of lower gastrointestinal hemorrhage and available diagnostic studies was performed. Management strategies based on the etiology of the bleeding and results of the diagnostic studies were discussed. An algorithm was provided to develop a diagnostic and therapeutic treatment strategy for lower gastrointestinal hemorrhage. Lower gastrointestinal hemorrhage can be a difficult and frustrating problem to both the clinician and the patient. Knowledge of the available diagnostic tests to help identify the source of bleeding is essential to the practicing clinician. Once the source is identified, management strategies and available treatment options need to be specific for each individual case. This review will aid the practicing physician in developing an algorithm for lower gastrointestinal hemorrhage.

Review article: the management of lower gastrointestinal bleeding

Several recent advances have been made in the evaluation and management of acute lower gastrointestinal bleeding. This review focuses on the management of lower gastrointestinal bleeding, especially acute severe bleeding. The aim of the study was to critically review the published literature on important management issues in lower gastrointestinal bleeding, including haemodynamic resuscitation, diagnostic evaluation, and endoscopic, radiologic, and surgical therapy, and to develop an algorithm for the management of lower gastrointestinal bleeding, based on this literature review. Publications pertaining to lower gastrointestinal bleeding were identified by searches of the MEDLINE database for the years 1966 to December 2004. Clinical trials and review articles were specifically identified, and their reference citation lists were searched for additional publications not identified in the database searches. Clinical trials and current clinical recommendations were assessed by using commonly applied criteria. Specific recommendations are made based on the evidence reviewed. Approximately, 200 original and review articles were reviewed and graded. There is a paucity of high-quality evidence to guide the management of lower gastrointestinal bleeding, and current endoscopic, radiologic, and surgical practices appear to reflect local expertise and availability of services. Endoscopic literature supports the role of urgent colonoscopy and therapy where possible. Radiology literature supports the role of angiography, especially after a positive bleeding scan has been obtained. Limited surgical data support the role of segmental resection in the management of persistent lower gastrointestinal bleeding after localization by either colonoscopy or angiography. There is limited high-quality research in the area of lower gastrointestinal bleeding. Recent advances have improved the endoscopic, radiologic and surgical management of this problem. However, treatment decisions are still often based on local expertise and preference. With increased access to urgent therapeutic endoscopy for the management of acute upper gastrointestinal bleeding, diagnostic and therapeutic colonoscopy can be expected to play an increasing role in the management of acute lower gastrointestinal bleeding.

The Management of Lower Gastrointestinal Bleeding in a Patient with Major Burns

The following report describes a rare complication with continuous hematochezia in a major burn patient due to transverse colon bleeding. The case of a 38 year-old male patient who developed sudden massive lower gastrointestinal bleeding two months after suffering 95% body surface area flame burns is presented. Emergent colonoscopy failed to localize the active bleeding sites. The RBC-technetium 99 was used as a detecting agent for definite identification of the bleeding points. Following unsuccessful conservative treatment, the operation of left hemicolectomy and the Hartmann's procedure was done. The hypovolemic shock due to massive bleeding was completely corrected. The patient resumed enteral feeding seven days after the surgical procedure.

Endoscopic Management of Lower Gastrointestinal Bleeding.

Colonoscopy continues to be the primary tool for diagnostic evaluation and management of lower gastrointestinal bleeding (LGIB). With the advent of newer endoscopy delivery therapeutic modalities, the treatment of LGIB has changed dramatically over the decades. The most dramatic change has been the role of surgery, which has been substantially reduced due to the therapeutic colonoscopy. This article reviews recent advances in the endoscopic treatment options in LGIB of the colon and rectum.

MDCT of Acute Lower Gastrointestinal Bleeding

We evaluated the use of MDCT in the diagnosis and management of lower gastrointestinal bleeding (hematochezia). MDCT is proposed as an alternative first-line investigation to locate lower gastrointestinal bleeding before placing the patient under observation or performing embolization or surgery.

Selective arterial embolization for control of lower gastrointestinal bleeding: recommendations for a clinical management pathway

Purpose Angiography remains as the modality of choice in the diagnosis of lower gastrointestinal bleeding. Traditionally, angiography is used for localization of a bleeding source for surgical resection. Advances in transcatheter techniques have allowed for hemorrhage control through embolization of bleeding points, without the need for emergent laparotomy. Methods A series of 10 consecutive patients who underwent angiographic embolization for lower gastrointestinal hemorrhage was retrospectively reviewed. Success and complication rates, as well as post-embolization follow-up methods, were recorded. Results Over a 3-year period, 10 angiographic embolizations were performed for lower gastrointestinal hemorrhage. Average age of the patients was 75 years. Source of hemorrhage included diverticular disease in 4 patients, cancer in 2, polyps in 2, angiodysplasia in 1, and anastomotic bleeding in 1. Six patients required no further therapy. Four patients went on to have surgery: Three secondary to recurrent hemorrhage, 1 due to sepsis from ischemic bowel necrosis. There were no deaths. Four patients had an abdominal and pelvic computed tomography (CT) scan within 48 hours of embolization. Four patients had a colonoscopy within 48 hours of the procedure. Conclusions Angiography remains an important diagnostic tool in the management of lower gastrointestinal bleeding. In addition, it is a safe and effective treatment option, especially in patients with high surgical risk. Hemorrhage control obtained in the angiography suite may allow for patient stabilization and resuscitation with staging and bowel preparation for surgery. Patients need to be carefully monitored for evidence of bowel ischemia through the use of colonoscopy or computed tomography.

The Therapeutic Barium Enema Revisited

The diagnosis and etiology of lower gastrointestinal bleeding from diverticulosis has been well-documented [1,2]. However, the clinical management of lower gastrointestinal bleeding remains a therapeutic dilemma for the physician. Although most bleeding episodes are mild and abate spontaneously with conservative therapy, there remains a subset of patients who present with persistent, massive lower gastrointestinal bleeding. It is the therapy of this subset that remains unde®ned. Although the mainstays in the treatment algorithm for lower gastrointestinal bleeding include the isotope bleeding test, angiography, colonoscopy, and eventual surgical resection for persistent bleeding, these procedures have associated morbidity and mortality [3]. Additionally, those patients whose bleeding persists despite conservative therapy are typically elderly, have associated atherosclerosis, and as a group are not optimal surgical candidates. For example, in a series of 49 patients who underwent total abdominal colectomy for persistent bleeding from diverticulosis, an operative mortality of 27% was reported [4]. In view of the signi®cant risk associated with these invasive procedures, there have been anecdotal reports of the use of the barium enema as a treatment for diverticular bleeding. We present a case where barium enema successfully stopped an episode of bleeding from diverticulosis, and review the literature.

Colonoscopic management of lower gastrointestinal hemorrhage.

Lower gastrointestinal bleeding is a common reason for hospitalization, especially among the elderly. Unlike that of upper gastrointestinal bleeding, the diagnostic and therapeutic approach to individuals with lower gastrointestinal bleeding is not well standardized. Recent reports indicate that early colonoscopy may be the best strategy to improve outcomes and reduce costs. However, good prospective, controlled data on the role of colonoscopy in the management of lower gastrointestinal bleeding are still required. Colonoscopy can establish a definite or probable diagnosis in greater than 80% of individuals with lower gastrointestinal bleeding. Based on the best available evidence, it appears that clinical and colonoscopic data may be combined in an effort to predict outcome and suggest optimal length of stay. It also appears that therapeutic colonoscopy can arrest or prevent bleeding in certain high-risk patients, offering the opportunity to change the natural history of the bleed.

Diagnosis and management of lower gastrointestinal bleeding

There are few randomized, prospective trials evaluating the optimal diagnostic and therapeutic strategies in the management of lower gastrointestinal bleeding. However, recent data suggest that urgent colonoscopy represents a safe and effective initial diagnostic approach. The role of tagged erythrocyte scintigraphy is yet to be defined, but it may be of utility as a screening test for visceral angiography. Colonoscopy and angiography both offer substantial therapeutic options but remain of unproved benefit from a treatment standpoint; surgery continues to play an important role in the management of lower gastrointestinal bleeding. Obscure gastrointestinal bleeding, which often presents as lower gastrointestinal bleeding, continues to be one of the most challenging diagnostic and therapeutic problems in gastroenterology. Occult gastrointestinal bleeding, often arising from the lower gastrointestinal tract, usually mandates gastrointestinal evaluation.

Urgent Colonoscopy for Treating and Diagnosing Lower GI Bleeding

The role of endoscopy in the management of lower gastrointestinal bleeding is uncertain. The authors of this study describe 10 years of experience using urgent colonoscopy for diagnosing and treating 121 consecutive patients with severe hematochezia and diverticulosis. All patients underwent colonoscopy for diagnosis of hematochezia within6 to 12 hours after hospitalization and after receiving oral or nasogastric sulfate purges (67% and 33%, respectively). Among the first 73 patients, 17 (23%) showed definite signs of diverticular hemorrhage (active bleeding in 6, …

Lower gastrointestinal bleeding.

Lower gastrointestinal bleeding can be a confusing clinical conundrum, the satisfactory evaluation and management of which requires a disciplined and orderly approach. Diagnosis and management has evolved with the development of new technology such as selective mesenteric angiography and colonoscopy. This study was undertaken to review the available data in the literature and to determine the current optimum method of evaluation and management of lower gastrointestinal hemorrhage most likely to result in a successful outcome. Data available on the topic of lower gastrointestinal bleeding in the English literature were obtained via MEDLINE search and were reviewed and analyzed. The colonic origin of lower gastrointestinal hemorrhage in order of decreasing incidence is diverticulosis, inflammatory bowel disease, including ischemic and infectious colitis, colonic neoplasia, benign anorectal disease, and arteriovenous malformations. Approximately 10 to 15 percent of all cases of rectal bleeding are attributable to a cause that is proximal to the ligament of Treitz. Small intestinal sources such as arteriovenous malformations, diverticula, and neoplasia account for between 3 and 5 percent of all cases. Colonoscopy successfully identified an origin in severe hematochezia in 74 to 82 percent of cases. Mesenteric angiography has a sensitivity of 42 to 86 percent. The best method of management depends on whether hemorrhage persists, the severity of continued hemorrhage, the cumulative transfusion requirement, and the specific origin of bleeding. Lower gastrointestinal hemorrhage is a complex clinical problem that requires disciplined and sophisticated evaluation for successful management. Diverticulosis is the most common cause. Colonoscopy is the diagnostic procedure of choice both for its accuracy in localization and its therapeutic capability. Selective mesenteric angiography should be reserved for those patients in whom colonoscopy is not practical. Precise identification of the bleeding source is crucial for a successful outcome. Specific directed therapy, such as segmental colonic resection for bleeding diverticulosis, is associated with the highest success rate and the lowest morbidity. A complete review of lower gastrointestinal bleeding is contained herein.

Effectiveness of current technology in diagnosis and management of lower gastrointestinal hemorrhage

Effectiveness of current technology in diagnosis and management of lower gastrointestinal hemorrhage