Surgical Treatment Concepts for Acute Lower Gastrointestinal Bleeding

Czymek, Ralf; Kempf, Alexander; Roblick, Uwe J.; Bader, Franz G.; Habermann, Jens K.; Kujath, P.; Bruch, Hans–Peter; Fischer, F.

doi:10.1007/s11605-008-0597-5

Cited by 45 publications

(28 citation statements)

References 45 publications

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“…Surgery for lower GI bleeding is usually reserved for patients with uncontrollable bleeding and failed angiographic embolization, or postembolization ischemic bowel complications (6,15). We did not encounter major complications in the 120 procedures in our study.…”

Section: Discussionmentioning

confidence: 71%

Acute lower gastrointestinal bleeding: predictive factors and clinical outcome for the patients who needed first-time mesenteric conventional angiography

Sıldıroğlu¹,

Muasher²,

Bloom³

et al. 2018

Diagn Interv Radiol

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M ost acute lower gastrointestinal (GI) bleeding stop spontaneously; therefore, no intervention or invasive diagnostic test such as conventional angiography is necessary (1). Prior to mesenteric arteriogram, colonoscopy, flexible sigmoidoscopy, and radionuclide imaging are usually performed. Recently computed tomography (CT) angiography has demonstrated promising results (1, 2). If the diagnostic tests locate the bleeding, or if intractable bleeding occurs, more invasive test warrants arteriogram and possible intervention. While other authors have performed similar analyses of patients with lower GI bleeding who required conventional angiography, they differed from our study in that some analyzed upper and lower GI bleeds together (3, 4), or patients with negative angiograms were not factored into the analysis (5), or more importantly, the patients were not separated in terms of first-time versus multiple bleeders (3)(4)(5)(6)(7)(8). We aimed to analyze patients with acute lower GI bleeding who presented to the emergency department for the first time and required conventional angiography for localization of the bleed and potential endovascular treatment. We also wanted to identify a subgroup of procedural factors, comorbidities associated with rebleeding, technical success, clinical success and mortality in association with lower gastrointestinal bleeds. Methods PatientsInstitutional review board approved this retrospective study. Consecutive cases of acute lower GI bleeding between 2001 and 2012 were reviewed retrospectively. We included all 23This project was an oral presentation in ARRS annual meeting in 2012. I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to investigate patients with lower gastrointestinal bleeding who presented to the emergency department requiring initial conventional angiography. We report risk-stratified and mesenteric conventional angiography outcomes. METHODSWe retrospectively reviewed patients with lower gastrointestinal bleeding between 2001 and 2012. We included all consecutive patients with clinical lower gastrointestinal bleeding with a requirement of further angiography and possible embolization. Patients who had prior interventions or surgery were excluded. RESULTSA total of 88 patients (35 women, 53 men) with a median age of 71 years (range, 23-99 years) were included in the analysis. Conventional angiography was positive and endovascular treatment was intended in 35 patients. Once the source of bleeding was found angiographically, endovascular treatment had a technical success rate of 90.3% and clinical success rate of 71.4%. Overall early rebleeding rate (<30 days) was 14.8% and late rebleeding rate (>30 days) was 13.6%. CONCLUSIONIdentifying the source of lower gastrointestinal bleeding remains to be a clinical and angiographic challenge. Although we did not observe an association between mortality and clinical success, increased early rebleeding rates were associated with higher mortality rates.You may cite this article as: Sıl...

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Section: Discussionmentioning

confidence: 71%

Acute lower gastrointestinal bleeding: predictive factors and clinical outcome for the patients who needed first-time mesenteric conventional angiography

Sıldıroğlu¹,

Muasher²,

Bloom³

et al. 2018

Diagn Interv Radiol

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“…Each has its own advantages and disadvantages. With evolving technology, the therapeutic options available to the patient allows for a decrease in mortality and morbidity as once emergent procedures are converted to semi-urgent or elective operations (72). …”

Section: Discussionmentioning

confidence: 99%

Acute Lower Gi Bleeding for the Acute Care Surgeon: Current Diagnosis and Management

2009

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AbstRAct:lower gastrointestinal bleeding is a common cause for hospital admission that results in significant morbidity and mortality. After initial resuscitation of the patient, the diagnosis and treatment of lower gastrointestinal bleeding remains achallenge for acute care surgeons. Identifying the source of bleeding can be difficult since many patients bleed intermittentlyorstopbleeding spontaneously.Itistherefore importantfor theacute care surgeon to be familiar with the different diagnostic and therapeutic modalities and their advantages and disadvantages in order to guide the management of the acutely bleeding patient. this review summarizes the current methods available for the diagnosis and treatment of acute lower gastrointestinal bleeding and proposes an algorithm for the management of these patients.

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“…Abb. 1 dargestellt und beruht neben den eigenen Erfahrungen [6] auf der Literatur der letzten 3 Jahrzehnte.…”

Section: Diagnostische Strategie Bei Akuter Gastrointestinaler Blutungunclassified

“…0,1 ml Blutverlust/min ist die Sensitivität der Radionuklidszintigraphie gegenüber der Angiographie höher [1], allerdings ist eine verwertbare Lokalisationsbestimmung insbesondere bei Spätauf-nahmen durch die zunehmende Hintergrundstrahlung nach 4-24 h nicht mehr verlässlich zu erhalten [13]. Verfahren wie die Kapsel-oder auch Push-Enteroskopie [6] zur Dünndarmevaluation haben in der Akutdiagnostik bis heute einen untergeordneten Stellenwert und wurden bei keinem der hier vorgestellten Patienten angewendet.…”

Section: Diagnostische Strategie Bei Akuter 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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Surgical Treatment Concepts for Acute Lower Gastrointestinal Bleeding

Cited by 45 publications

References 45 publications

Acute lower gastrointestinal bleeding: predictive factors and clinical outcome for the patients who needed first-time mesenteric conventional angiography

Acute lower gastrointestinal bleeding: predictive factors and clinical outcome for the patients who needed first-time mesenteric conventional angiography

Acute Lower Gi Bleeding for the Acute Care Surgeon: Current Diagnosis and Management

Die Operation als Notfalltherapie bei akuter gastrointestinaler Blutung

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