Major lower intestinal haemorrhage. Angiographic localisation and current management.
Thirty-four patients with major lower intestinal bleeding underwent emergency selective mesenteric angiography during a 6-year period. Angiography identified a bleeding site in 16 patients (47%). Diverticulosis, found in 22 patients (65%), and angiodysplasia, found in 4 (12%), were the most common causes of major colonic bleeding and originated more frequently from the right colon. Eight patients (24%) bled from less common sources. Radiological control of bleeding was unreliable with a significant complication rate. Fourteen of 16 patients with positive angiograms and 6 of 18 patients with negative angiograms required surgery for persistent major bleeding. Angiographic localisation of colonic bleeding allowed limited resection in 9 of 11 patients with control of haemorrhage in 8 (89%). Fourteen of 34 patients were managed non-operatively; of these 2 had minor recurrent bleeding. The overall mortality rate was 29%, the operative mortality rate 40% and the non-operative mortality rate 14%. A rational diagnostic approach is presented, emphasising the role of selective mesenteric angiography in the management and surgical strategy of major lower intestinal bleeding.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D003108:Colonic Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged