[Surgical treatment of lower digestive tract hemorrhage. Experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán].
BACKGROUND
Lower gastrointestinal bleeding is usually self-limiting in about 80% of cases; however, surgical treatment may be required in selected cases. Preoperative precise identification of the bleeding source is crucial for a successful outcome.


OBJECTIVE
To determine the most frequent diagnoses, as well as short and long-term results in a series of patients who underwent a surgical procedure for lower gastrointestinal bleeding.


METHODS
Retrospective analysis of 39 patients operated upon for lower gastrointestinal bleeding from 1979 through 1997 in a referral center. Demographic data, history, physical examination, laboratory tests, resuscitative measures, preoperative work-up for identification of bleeding source, definitive cause of bleeding, surgical procedure, operative morbidity and mortality, as well as long-term status and recurrence of bleeding were recorded.


RESULTS
There were 54% women and 46% men. Mean age was 56 years (range, 15-92). Most patients presented hematochezia (69%). Colonoscopy was the most used diagnostic procedure (69%). The bleeding source was located in 90% of patients. Diverticular disease was the most frequent cause of bleeding. A segmental bowel resection was the treatment in 97% of cases. Morbidity was 23% with 18% of mortality. Recurrence occurred in 9% of survivors.


CONCLUSIONS
Morbidity and mortality were high. Patients who require a surgical operation should be carefully selected and evaluated with a complete work-up to determine the site and cause of bleeding.
García-Osogobio
Sandra
S
Departamento de Cirugía, Servicio de Cirugía de Colon y Recto, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F.
Remes-Troche
José María
JM
Takahashi
Takeshi
T
Barreto Camilo
Juan
J
Uscanga
Luis
L
D000047:Academies and Institutes / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000706:statistics & numerical data; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D003113:Colonoscopy / Q000706:statistics & numerical data; D003125:Colostomy / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004238:Diverticulitis / Q000150:complications; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies
Tratamiento quirúrgico de la hemorragia del tubo digestivo bajo. Experiencia en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.