title: [Severe lower gastrointestinal tract hemorrhage in adults. Apropos of 38 cases].
abstract: Retrospective study of 38 cases of serious intestinal or rectal hemorrhage in the adult occurring between 1974 and 1987 demonstrated a wide variety of lesions responsible. Malignant tumours (21%) and ischemic lesions (13%) were most often implicated. Colonic diverticulosis and angiodysplasia were each responsible for 8% of cases. The most effective means of exploration were rectosigmoidoscopy and coelio-mesenteric arteriography together with per-operative endoscopy. The diagnosis remained uncertain in only 8% of cases. Treatment was essentially surgical (32 patients). Post-operative mortality (26%) was high, in keeping with the severity of the lesion responsible for the hemorrhage. Serious lower intestinal hemorrhage requires a two-fold management: the institution of intensive care resuscitation and as soon as the patient state permits, etiological investigation. After recto-sigmoidoscopy, which generally allows lower intestinal hemorrhage to be eliminated, arteriography and per-operative colonoscopy have in our experience a high diagnostic yield in cases of persistent hemorrhage. Where bleeding stops spontaneously, colonoscopic examination, after suitable preparation, remains a worthwhile investigation.
authors.affiliation: CHU Charles Nicolle, Rouen.
authors.forename: C
authors.initials: C
authors.lastname: Peillon
authors.forename: H
authors.initials: H
authors.lastname: Steyaert
authors.forename: T
authors.initials: T
authors.lastname: Delaunay
authors.forename: B
authors.initials: B
authors.lastname: Lammens
authors.forename: J
authors.initials: J
authors.lastname: Testart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000002:abnormalities; D003108:Colonic Diseases / Q000150:complications*; D003113:Colonoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007422:Intestines / Q000098:blood supply; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging; D008875:Middle Aged; D011859:Radiography; D012002:Rectal Diseases / Q000150:complications*; D012189:Retrospective Studies
vernacular_title: Les hémorragies digestives basses graves de l'adulte. A propos de 38 observations.