Diagnosis and Management of Massive Lower Gastrointestinal bleeding

Abstract

For the past ten years, twenty-four patients with massive lower gastrointestinal bleeding (M.L.G.I.B.) have been treated at Keio University Hospital. Although, M.L.G.I.B. is less common, compared with upper G.I. bleeding, it is often associated with severe underlying disease which make the prognosis poor. From the analysis of our cases, we described here the diagnosis and management of M.L.G.I.B..
We consider both proctosigmoidoscopy and angiography are the most useful techniques for localizing the bleeding sites, and subsequently hemostasis using tamponade, direct liga-ture of blood vessel and transcatheter hemostasis can be employed. Bleeding sites could be detectable with proctosigmoidoscopy in thirteen cases. In seven of eight cases the bleeding sites were identified by angiography, performed in active hemorrhagic period. Colonoscopy and barium enema had limited roles in diagnostic evaluation for M.L.G.I.B. because of unprepared bowels.
Most cases of M.L.G.I.B. required surgical operation eventually, and in thirteen of our cases surgical intervention was performed. Elective surgery is a choice, if possible, and emergent surgery is indicated only when the diagnosis is made and bleeding cannot be controlled by non-operative means.
Seventeen patients had some disorders, including blood dyscrasia, cerebral hemorrhage, collagen disease, malignancy, portal hypertension etc., and we must be reminded that a patient with M.L.G.I.B. might have a serious disease.