PMID- 16420847
OWN - NLM
STAT- MEDLINE
DCOM- 20060404
LR  - 20191109
IS  - 0009-739X (Print)
IS  - 0009-739X (Linking)
VI  - 78
IP  - 5
DP  - 2005 Nov
TI  - [Emergency surgery in severe lower gastrointestinal hemorrhage].
PG  - 308-11
AB  - INTRODUCTION: There are no conclusive studies that would allow us to distinguish 
      between patients with severe lower gastrointestinal hemorrhage (LGIH) who require 
      emergency surgery and those who do not. The aim of the present study was to 
      determine the clinical and epidemiological factors that would allow us to 
      distinguish between severe LGIH requiring emergency surgery and self-limiting 
      LGIH and to analyze the surgical management of these patients. MATERIAL AND 
      METHODS: We reviewed 175 patients with LGIH (severe rectal bleeding with a 
      decrease in hematocrit > or = 10 points or transfusion of at least three units of 
      packed red blood cells) treated between 1980 and 2002 and selected 28 patients 
      (16%) who required emergency surgery. The control group consisted of patients 
      with LGIH who did not require surgery. Student's t-test and the Chi-squared test 
      were used in the statistical analysis. RESULTS: Comparison of severe LGIH 
      requiring emergency surgery with self-limiting LGIH revealed three variables that 
      could serve as a guide to differentiating between these entities, namely: age 
      less than 80 years (p = 0.013), the presence of hypotension on arrival at the 
      emergency department (p < 0.0001), and cause of bleeding (p < 0.0001). Among 
      patients requiring emergency surgery, the origin was ano-rectal in nine (32%) and 
      consequently the approach used was perianal. In the remaining patients (n = 19) 
      the abdominal approach was used. In 10 patients, etiologic diagnosis was not 
      available before surgery and the source of bleeding was identified during the 
      intervention in 6 of these patients. In the four remaining patients without 
      etiological diagnosis before surgery, subtotal colectomy was performed. In the 
      remaining patients, local resection of the affected area was performed (3 right 
      hemicolectomies, 9 small bowel resections, and 3 resections of Meckel's 
      diverticulum). Morbidity was 18% and mortality was 7%. CONCLUSION: Distinguishing 
      between self-limiting LGIH and LGIH requiring emergency surgery is difficult. In 
      our series, the only factors predictive of emergency surgery were hemodynamic 
      instability on arrival at the emergency department and age less than 80 years. 
      Cause of bleeding is not a predictive factor as it generally unknown at symptom 
      onset.
FAU - Rios, Antonio
AU  - Rios A
AD  - Servicio de Cirugia General y Digestivo I, Departamento de Cirugia, Hospital 
      Universitario Virgen de la Arrixaca, El Palmar, Murcia, Espana. 
      ARZRIOS@teleline.es
FAU - Montoya, Mariano Jaime
AU  - Montoya MJ
FAU - Rodriguez, Jose Manuel
AU  - Rodriguez JM
FAU - Parrilla, Pascual
AU  - Parrilla P
LA  - spa
PT  - English Abstract
PT  - Journal Article
TT  - Cirugia urgente en las hemorragias digestivas bajas graves.
PL  - Spain
TA  - Cir Esp
JT  - Cirugia espanola
JID - 1254104
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Diagnosis, Differential
MH  - *Emergency Treatment
MH  - Female
MH  - Gastrointestinal Hemorrhage/diagnosis/epidemiology/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Severity of Illness Index
EDAT- 2006/01/20 09:00
MHDA- 2006/04/06 09:00
CRDT- 2006/01/20 09:00
PHST- 2006/01/20 09:00 [pubmed]
PHST- 2006/04/06 09:00 [medline]
PHST- 2006/01/20 09:00 [entrez]
AID - 13080754 [pii]
AID - 10.1016/s0009-739x(05)70940-4 [doi]
PST - ppublish
SO  - Cir Esp. 2005 Nov;78(5):308-11. doi: 10.1016/s0009-739x(05)70940-4.