Management of massive lower gastrointestinal bleeding: should there be surgical intervention without initial endoscopy and radiological evidence of the source of bleeding?

European Journal of Internal Medicine
Eric-Jan A. KrootDirk Jan Bac

Abstract

We report two case histories of patients with massive rectal blood loss. Endoscopic and radiological investigations could not identify the source of bleeding at admission. Initially, both patients recovered without surgical intervention, receiving a large number of blood transfusions only. Extensive subsequent radiological analysis showed that the bleeding was due to a pathological part of the proximal jejunum in one case and of the colon transversum in the other. Although immediate surgical intervention was not needed at presentation, both patients underwent resection of a part of the bowel some time thereafter. Surgery was performed after hemodynamic stabilization in the first case. However, in the second case, emergency surgical intervention was needed due to persistent bleeding 4 days after admission. Both patients are still doing well half a year after this massive gastrointestinal (GI) hemorrhage. Aside from a small area of chronic inflammation and fibrosis of the jejunum in one patient, histopathological evaluation of the surgical resection specimens revealed no specific cause for these massive gastrointestinal bleedings. We discuss the general approach of gastrointestinal hemorrhage and the several (dis)advantages of th...Continue Reading

References

Nov 1, 1986·Annals of Surgery·W BrowderM S Litwin
Oct 1, 1993·AJR. American Journal of Roentgenology·D A ZuckermanE H Birnbaum
Jul 1, 1996·Diseases of the Colon and Rectum·J T EmslieR W Beart
Feb 19, 2000·Journal of Gastroenterology·N HamadaA Taira
Jan 24, 2002·Clinical Nuclear Medicine·Borys R KrynyckyiLeonard M Freeman
Jul 5, 2002·World Journal of Surgery·Aayad R Al QahtaniPhilip H Gordon
Aug 27, 2002·European Radiology·José I BilbaoAntonio Martínez-Cuesta

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Citations

Jan 25, 2006·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·E KlarT Foitzik

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