Emergency surgery for acute colonic haemorrhage—A retrospective study

Eaton, A. C.

doi:10.1002/bjs.1800680214

Cited by 46 publications

(16 citation statements)

References 22 publications

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“…Great effort should be made to identify the site of bleeding to limit colonic resection, because blind segmental resection is associated with a significant rebleeding rate and increased morbidity and mortality (up to 25% has been reported) [44,88,89,90,91]. Limited intestinal resection following angiographic localization of the bleeding site has significantly lower morbidity than surgery of historic controls without angiography (8.6% vs 37%) [54,92].…”

Section: Surgerymentioning

confidence: 99%

Diverticular disease-associated hemorrhage in the elderly

Buttenschoen

Odermath

et al. 2001

Langenbeck's Archives of Surgery

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Lower gastrointestinal bleeding is frequent in the elderly secondary to diverticular disease and occurs in about 10-30%. It is the most frequent cause of lower gastrointestinal hemorrhage (about 40% of cases) followed by angiodysplasia (up to 20% of cases). The incidence of both diseases increase with age, but the patient's general condition and state of health decrease. Often cardiovascular morbidity coexists, resulting in an eventual risk of ischemic consequences. The intensity of bleeding varies from massive to occult. In diverticular disease, hemorrhage is caused by rupture or erosion of the vasa recti stretched by diverticula. Classically inflammation is absent. Although most diverticula (> 90%) are located in the sigmoid colon, bleeding originates more frequently from the right (> 50%) than the left colon. The preferred diagnostic tool following resuscitation is colonoscopy with an ability to locate the site of bleeding in up to 90% of cases. Additionally, injections and thermocoagulation are available to control bleeding endoscopically with a success rate of about 27%. Angiography is considerably variable concerning positive results (13.6-86%), has a complication rate of about 10% and is expensive. Hence, it is a second-line diagnostic method. Diverticular hemorrhage will cease spontaneously in about 90% of cases. Therefore, conservative treatment is preferred. Patients with persistent, massive or recurrent bleeding despite active conservative measures require surgical treatment. If surgical intervention is necessary, the site of hemorrhage must be sought to allow segmental resection. However, if the source of blood loss cannot be located, a subtotal colectomy is justified.

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Section: Surgerymentioning

confidence: 99%

Diverticular disease-associated hemorrhage in the elderly

Buttenschoen

Odermath

et al. 2001

Langenbeck's Archives of Surgery

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“…A high rate of intraperitoneal sepsis [5] following enterotomy dehiscence of the unprepared gut weighs heavily against such procedures. Therefore, mortality rates of emergency surgery for unidentified bleeding show values up to 50% [1][2][3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a large number of emer gency operations had to be performed in unidentified bleeding. Of course, it was the surgeon who was blamed for the inevitable high mortality of up to 50% [1][2][3][4][5][6],…”

Section: Introductionmentioning

confidence: 99%

Orthograde Lavage in the Treatment Policy of Acute Intestinal Bleeding

et al. 1990

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A new diagnostic and therapeutic schedule including orthograde lavage as a major element was applied to 97 patients. It provided excellent conditions for a specific use of diagnostic procedures without any adverse side effects. Cases with active severe bleeding underwent angiography; patients with inactive or low-intensity bleeding underwent colonoscopy. This enabled to radiographically visualize the bleeding source in 92% of the cases and to increase the predictive value of endoscopy to 98%. Two different therapeutic procedures were used. In one group of patients (group A; n = 62) endoscopic injection therapy was performed as a definitive step whenever possible. The other patients of this group underwent emergency surgery. A second group of patients (group B; n = 35) underwent endoscopic therapy only for a temporary control of the bleeding, followed by early elective surgery. Mortality rates were 5% in group A and 6% in group B.

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“…Diese Ergebnisse bestätigen eine Beobachtung von Eaton [10], der die Mortalität bei einem Transfusionsbedarf von mehr als 2 Einheiten Blut auf 15% ansteigen sah. Es herrscht weitgehender Konsens, dass aus einem Transfusionsbedarf größer 4 bis 6 Einheiten Blut über 24 h die Indikation für eine chirurgische Intervention erwächst.…”

Section: Risikoanalyse Bei Akuter Unterer Gastrointestinaler Blutungunclassified

Die Operation als Notfalltherapie bei akuter gastrointestinaler Blutung

Czymek

Grossmann

Roblick

et al. 2010

Chirurg

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Examination and stabilization of the patient is directly followed by diagnostic localization. The indication for surgery is mainly limited to peracute, uncontrollable and recurrent forms of gastrointestinal bleeding. The mortality rate for these critically ill, negatively selected patients remains high and could not be lowered in the last decade. Postoperative need of ventilation is a predictor for poor prognosis.

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Emergency surgery for acute colonic haemorrhage—A retrospective study

Cited by 46 publications

References 22 publications

Diverticular disease-associated hemorrhage in the elderly

Diverticular disease-associated hemorrhage in the elderly

Orthograde Lavage in the Treatment Policy of Acute Intestinal Bleeding

Die Operation als Notfalltherapie bei akuter gastrointestinaler Blutung

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