Acute Lower Gastrointestinal Hemorrhages in Geriatric Patients

Abstract

Age is a risk factor in acute lower gastrointestinal hemorrhages (LGIH). The objectives here were to analyze: (1) diagnostic and therapeutic handling, (2) related morbidity and mortality, (3) the indications for surgery, and (4) the evolution of acute LGIH in patients > or =80 years. Forty-three patients >80 years with acute LGIH were reviewed retrospectively. In 86% (n = 37) related comorbidities were found, in 9% (n = 4) there had been prior colorectal surgery, 19% (n = 8) were antiaggregated, and 7% (n = 3) were anticoagulated. One hundred thirty-two cases of acute LGIH in patients <80 years were used as a control group. Student's t test and the chi-square test were applied. On arrival at the emergency ward 11 cases (26%) had hemodynamic instability and 8 of these were stabilized using conservative measures. In 39 cases an endoscopy was performed, allowing for an etiological diagnosis in 59% (n = 23) of cases, above all in those carried out in an urgent or semiurgent way. The arteriography permitted an etiological diagnosis in two of the four cases in which it was carried out. In seven patients (16%) urgent surgery was indicated: three were hemorrhoidectomies, three were subtotal colectomies, and one was a resection of the small intestine. The morbidity rate was 10% (n = 4) in the patients who were not treated and 14% (n = 1) in those treated, with a mortality rate of 8% (n = 3) and 14% (n = 1), respectively. The rate of relapse of bleeding after discharge from hospital was 42% (n = 18), with nine of these needing to be readmitted into hospital. In comparison with the control group, they present a different bleeding etiology (diverticulosis as opposed to the benign anal-rectal and small intestinal pathology in the younger population; P = 0.017), surgery is indicated with less frequency (9 versus 33%; P = 0.007), and there is a higher relapse rate (42 versus 26%; P = 0.045). Acute LGIH in geriatric patients relents in most cases with the use of conservative measures, although there is a high percentage of related morbidity and mortality, and of relapse of bleeding.

Immediate unprepared polyethylene glycol‐flush colonoscopy in elderly patients with severe lower gastrointestinal bleeding

“…In accordance with the literature, the most common causes of bleeding were diverticular hemorrhage and angiodysplasia (46%–61%) . We found angiodysplasia and diverticular hemorrhage in 69.7% of cases.…”

Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis

“…The utility of colonoscopy to confirm the anastomotic bleeding has been suggested, and the safety of sclerotherapy, clips or electrocoagulation to stop the haemorrhage has been investigated [4,5,9,12]. However, and depending on hospital policy or availability, angiographic localization and bleeding control using vasopressin or direct embolization could be a safe alternative as has been reported [13].…”

Multidetector CT evaluation in Gastro-Intestinal Bleeding

“…In Asia, hemorrhoids are a common cause of lower gastro-intestinal bleeding followed by anal fissures and colorectal neoplasms. (19) (vi) Diverticulitis 1 (2.7%) patient had shown multiple, small, diverticuli in the sigmoid colon and descending colon with few of the diverticuli in the descending colon showing wall edema, heterogeneous enhancement and peri-colic fat stranding favoring diverticulitis on CT scan (Fig. 7).…”