The Management of Lower Gastrointestinal Hemorrhage

Hoedema, Rebecca; Luchtefeld, Martin

doi:10.1007/s10350-005-0138-1

Cited by 93 publications

(77 citation statements)

References 80 publications

(69 reference statements)

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“…Mesenteric angiography is one of the most often used procedures for diagnosis and treatment of an acute lower GI bleed, with a yield reported to be between 19%-92% [9][10][11] . In a review by Vernava et al [12] , mesenteric angiography localized the bleeding sites in 40% to 86% in 9 different studies.…”

Section: Discussionmentioning

confidence: 99%

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Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

Rasuli¹

2014

WJR

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AIM:To assess if certain triaging rules could be estab lished to optimize the yield of mesenteric angiography. METHODS:Medical records of 101 patients were ret rospectively reviewed and parameters relating to age, gender, pulse rate, blood pressure, serum hemoglobin, intensive care unit (ICU) admission, and the number of packed red blood cells (PRBC) transfused in the 12 and 24 h prior to the angiography were tabulated in two groups with positive and negative angiography results. RESULTS:We found no correlation between gender, pulse rate, blood pressure or serum hemoglobin and positivity of the mesenteric angiogram. But patients with positive angiogram were found to be on average 7 years older (73.2 years vs 65.9 years old) (P = 0.02).Angiogram was positive in 39.3 % (11/28) of patients admitted in ICU vs 23.2% (17/73) who were admitted elsewhere in the hospital (P = 0.03). In the 12 and 24 h prior to angiography, patients with a positive angio gram received a mean of 2.7 ± 2.3 and 3.3 ± 2.6 units of PRBC s respectively, while patients with a negative angiogram had a mean of 1.6 ± 1.9 (P = 0.02) and 2.1 ± 2.6 units (P = 0.04) received respectively in the same period. CONCLUSION:Older age, ICU admission, having re ceived at least 4 units PRBC over 12 h or 5 units over 24 h prior to angiogram are leading indicators for a positive study.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Angiography; Diagnostic use; Colon; Blood supply; Radiograph; Gastrointestinal hemorrhage; Emer gencies; Mesenteric arteries Core tip: Mesenteric angiography is associated with a low yield of about 30%. We evaluated several factors in 101 patients undergoing mesenteric angiography in a tertiary care institution to see if any could be used for predicting a positive angiogram. We found that vital signs are poor discriminators but older age, intensive care unit admission, having received at least 4 units PRBC over 12 h or 5 units over 24 h prior to angiogram are leading indicators for a positive study. We postulate that the reason is that patients are given enough blood units to compensate for blood loss and stabilize vital signs and therefore the number of blood units given indirectly correlate with severity of active bleeding.Rasuli P, Doumit J, Boulos M, Rizk C, Doumit G. Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed. World J Radiol 2014; 6(5): 218-222 Available from:

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Section: Discussionmentioning

confidence: 99%

“…Mesenteric angiography is used either after a positive technetium 99 m (99 m Tc)-RBC scintigraphy in case of intermittent bleeding [10] , or after a positive CT [8] . In cases of massive bleeding in order to avoid emergent surgery which could lead to total colectomy and a higher morbidity and mortality straight angiography may be undertaken.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

Rasuli¹

2014

WJR

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“…2-3 ml of extravasated blood is sufficient for detection. [20,21] Another advantage brought about by this technique is the capability of long-term imaging (up to 24 hours) due to circulation of radioactively marked erythrocytes in the blood pool. [22][23][24] Timing for scintigraphy is important for determining bleeding localization correctly.…”

Section: Discussionmentioning

confidence: 99%

Role of red blood cell scintigraphy for determining the localization of gastrointestinal bleeding

Şanlı

Özkan²,

Kuyumcu³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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AMAÇGastrointestinal sistem (GİS) kanamalarında kanama odağı-nın saptanmasında, Tc-99m ile işaretli eritrosit (RBC) sintigrafisinin rolü klinik deneyimlerimiz ışığında değerlendirildi. GEREÇ VE YÖNTEM1995-2010 yılları arasında GİS kanaması odağının belirlenmesi amacıyla kliniğimize gönderilen 57 hasta (27 kadın, 30 erkek; ortalama yaş 43.9±24; dağılım 1-91 yıl) geriye dönük olarak çalışmaya alındı. Sintigrafi öncesi hastaların 51'ine gastroskopi, 45'ine kolonoskopi, 9'una anjiyografi yapılmıştı. BULGULARRBC sintigrafisi hastaların 31'inde pozitif ve 26'sında negatifti. Pozitif sintigrafik bulgular, 19 hastada ilk bir saatlik dinamik imajlarda, 7 hastada 1-4. saatler arası statik imajlarda, 5 hastada ise 4-24. saatler arasında alınan statik imajlarda kaydedildi. Toplam 14 hasta GİS kanaması nedeniyle ameliyat edildi. On üç hastada kanama yeri RBC sintigrafisi tanısıyla doğrulandı (doğruluk: %92,8). Ameliyat edilmeyen 43 hastanın 12'sinde nedeni bilinmeyen demir eksikliği anemisi vardı ki bu hastaların tümünde sintigrafi negatif olarak sonuçlandı. Yoğun kanama bulguları olan 4 hasta medikal takip sürecinde kaybedildi, geri kalan 27 hastanın kanamaları kendiliğinden ya da konservatif tedavilerle durdu. SONUÇÇalışmamız aktif GİS kanamalarında kanama odağının belirlenmesinde sintigrafinin primer yöntem olması gerekliliğini göstermektedir. Özellikle ilk 1 saatlik dinamik görün-tüleme esnasında saptanan pozitif imajlar, kanama odağı-nın doğru yerinin saptanmasında ve cerrahi gerekliliğin belirlenmesinde yol göstericidir.Anahtar Sözcükler: Gastrointestinal kanama; işaretli eritrosit sintigrafisi; endoskopik girişimler.

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“…In patients with significant hematochezia, colorectal causes account for 70-80%, an upper GI source is the cause in 10-15% while the small bowel is the cause in 0.7-25% (Farrell 2005;Hoedema 2005). Common anorectal problems are haemorrhoids, fissure, proctitis, cancer and trauma.…”

Section: Introductionmentioning

confidence: 99%

Practical Issues in the Decision Making and Management of Acute lower Gastrointestinal Bleeding: An Algorithmic Approach

2017

International Journal of Research Studies in Medical and Health

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ABSTRACT:Acute lower Gastro intestinal bleeding is a relatively common problem in the emergency department. Etiology is diverse as is the degree of bleeding and natural history. Hence there are a number of subtle aspects of clinical assessment, investigations and management which require attention and application fr optimal outcomes. The goal of this review is to highlight the practical issues in managing the condition from the perspective of a medical officer or a junior resident in surgery who is on-call in the emergency department. A working algorithm incorporating the key management issues is also presented.

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The Management of Lower Gastrointestinal Hemorrhage

Cited by 93 publications

References 80 publications

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed

Role of red blood cell scintigraphy for determining the localization of gastrointestinal bleeding

Practical Issues in the Decision Making and Management of Acute lower Gastrointestinal Bleeding: An Algorithmic Approach

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