Management of massive lower gastrointestinal hemorrhage

Albo, Robert J.; Grimes, Orville F.; Dunphy, J. Englebert

doi:10.1016/0002-9610(66)90018-3

Cited by 18 publications

(2 citation statements)

References 4 publications

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“…Nevertheless, this diagnosis was never a very satisfactory one since bleeding often appeared to come from the right colon where diverticula are much less common than on the left. A partial explanation was given when Wilkie [1] in 1937 and Albo, Grimes, and Dunphy [2] in 1966 described isolated tiny ulcers of the ascending colon that were associated with hemorrhage.…”

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confidence: 99%

Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease

1978

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A series of 72 patients with bleeding either from angiodysplasia or diverticular disease of the colon has been studied in the Massachusetts General Hospital. Modern angiographic techniques have dispelled much of the mystery and reduced the mortality of colonic bleeding. In this series 85% of the bleeding originated from the right or transverse colon. Of the 72 patients, 70 survived; there were 52 operations. The 2 deaths occurred in an 81‐year‐old patient after subtotal colectomy and an 84‐year‐old patient after right colectomy, both for diverticular bleeding. After discharge from the hospital, 67 patients have been followed up for a median interval of 22 postoperative months. Late follow‐up of patients with bleeding from either angiodysplasia or diverticula showed that segmental resection was successful in stopping bleeding in 38 of 42 patients (90%); the 10 patients who had subtotal colectomy had no recurrent bleeding. The choice of operation must depend upon many factors that reflect operative risks, which must be balanced against better control of bleeding by subtotal colectomy. Because a right colectomy for angiodysplasia has been followed by recurrent bleeding in 4 of 31 cases, it is suggested that the right half of the transverse colon be included in the right colectomy since this will introduce no greater hazard and may lead to better control of bleeding. Subtotal colectomy is the operation of choice for bleeding from the colon from an unknown source, in good‐risk patients with widespread diverticulosis involving all segments of the colon, and for a combination of angiodysplasia on the right and extensive diverticular disease on the left. In poor‐risk patients, if either angiodysplasia or a single bleeding point has been demonstrated by selective arteriography, a segmentai resection of that area will be the safest procedure.

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Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease

1978

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“…Πολλάκις öμως ή διάγνωσις αυτή δέν ήτο ικανοποιητική, ιδίως εις πε ριπτώσεις εις τάς όποιας ή αιμορραγία έφαίνετο προερχομένη άπό τό δεξιόν ήμισυ του παχέος έντερου καί κυρίως κατά τήν ώραν τής έγχειρήσεως, όπου ένώ διενερνειτο αριστερά ήμικολλεκτομή, ή αιμορραγία έσυνεχίζετο άπό τό εναπομείναν δεξιόν -43κόλον . Μία μερική έξήγησις της καταστάσεως αυτής εδόθη από τον Wilkie (1937) 182 καιτόν Albo (1966) 2 , οί οποίοι περιέ γραφαν μεμονωμένα μικρά έλκη του ανιόντος κόλου τά οποία συνεδυάζοντο μέ αίμορρανίαν. Ό Corry (1970) 57 αναφέρει πέντε περιπτώσεις "διαβρώσεως του τυφλού" είς τάς οποίας τά Ιστολογικά ευρήματα εξεταζόμενα σήμερον αναδρομικώς εί ναι συμβατά μέ άγγειοδυσπλασίας.…”

Section: σιγμοειδοσκόπησιςunclassified