Acute lower gastrointestinal bleeding: SPECIFIC CAUSES OF LGI BLEEDING Part 8
Inflammatory bowel disease: Despite that ulcerative colitis and Crohn’s disease are characterized by bleeding and diarrhea, massive hematochezia is uncommon, occurring in only 3% to 5% of all patients with massive LGI bleeding. Up to 6% of patients with Crohn’s disease or ulcerative colitis experience severe LGI bleeding. The incidence may be slightly higher in Crohn’s disease, secondary to the transmural nature of the disorder. In Crohn’s disease, the distribution of bleeding reflects the frequency with which an area of the bowel is affected, with the ileum being the most commonly affected. Most patients with Crohn’s disease who present with massive hema-tochezia are known to have had Crohn’s disease for at least several years. Medical therapy is usually the initial treatment choice because therapy for the underlying disorder may result in control of hemorrhage. Unfortunately, although 50% of patients stop bleeding spontaneously, 35% will rebleed; thus, an urgent colectomy is recommended for patients with colitis who suffer a life-threatening hemorrhage. Proctectomy is reserved for patients in whom the rectum is the primary site of bleeding. In ulcerative colitis, colectomy and end ileostomy with preservation of the rectal stump (to allow elective proctectomy and construction of an ileoanal reservoir at a later date) are recommended methods of resection; in Crohn’s colitis, colectomy with ileoproctostomy (provided that the rectum is not inflamed or not the site of bleeding) is recommended. You have a great opportunity to find to feel one lucky customer.