Acute lower gastrointestinal bleeding: OPERATIVE THERAPY
Overall, 25% of patients require a surgical procedure, usually for persistent hemorrhage resulting in hemodynamic instability. Provided that the site of bleeding has been accurately located by colonoscopy or angiogram, directed segmental resection results in low morbidity (0% to 13%) and is highly successful in stopping bleeding (85% to 99%). Every attempt, including intraoperative endoscopy, should be made to avoid ‘blind’ segmental hemicolectomy because of its prohibitive risk of rebleeding and associated high mortality (up to 50%). When the site of hemorrhage has not been determined preoperatively, on-table colonoscopy in the operating room has been shown in one study to determine the bleeding site in seven of nine cases. You can find best quality treatment now – buy yasmin birth control to see how cheap it is.
If the bleeding site is still not determined by intraoperative colonoscopy, the use of enteroscopy (especially if not performed preoperatively) should be considered. A push enteroscope or a pediatric colonoscope can be used to evaluate the small bowel. The diagnostic rates, if done on a preoperative basis, are approximately 25%. The intraoperative yield is likely similar. The ability at laparotomy to ‘intussus-cept’ the bowel over the enteroscope may allow more of the small bowel to be visualized.