Diagnostic approach and management of active lower gastrointestinal hemorrhage.
We evaluated 67 patients with acute bleeding of the lower gastrointestinal tract, for diagnostic accuracy of colonoscopy, and scintigraphy. Fifty-nine patients were stable after initial resuscitation and underwent colonoscopy. The source of hemorrhage was identified in 30 patients (50.8%). Tc-labeled red blood cells scintigram was undergone in 23 patients with a sensitivity of 43.4%. The identification of the bleeding source reached 75.4% when colonoscopy was used in combination with scintigraphy. Eleven patients with lower gastrointestinal bleeding requiring transfusion of 5 units of red blood cells or more had a diagnostic exploratory laparotomy, and the diagnosis was ascertained during operation in nine. The postoperative mortality rate was 18.1%. We conclude that in patients with active gastrointestinal bleeding, colonoscopy in combination with scintigraphy detect at a higher rate the cause and the site of bleeding and possibly improve the prognosis.
2nd Department of Propedeutic Surgery, Faculty of Medicine, School of Health Science, University of Athens, Greece.
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G
Kouraklis
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Misiakos
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Karatzas
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Gogas
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Skalkeas
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000473:pathology / Q000601:surgery; D003108:Colonic Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy; D003937:Diagnosis, Differential; D004912:Erythrocytes; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013667:Technetium
D013667:Technetium