Surgery 6th year, Tutorial (Dr. AbdulWahid)

Lower GI Hemorrhage

ABDWAHID M SALIS, M.D

LGI hemorrhage

Colon – 95-97%

Small bowel – 3-5%Only 15% of massive GI bleedingFinding the site

Intermittent bleeding common

Up to 42% have multiple sites

Hematochezia: Bright red stool, called, is the sign of a fast

moving active GI bleed

Maroon color:

short time taken from the site of the bleed and the exiting at the anus

Causes

Coagulopathy - specifically a bleeding diathesis

Bleeding diverticulosis

Colonic angiodysplasia

Diverticulosis – 40-55%

90% stop spontaneously

10% rebleed in 1st year

and 25% at 4 years

Angiodysplasia – 3-20%

– >50 y/o–>50% are in right colon

argon plasma coagulation

Neoplasia

–Typically bleed slowly

–Polyps

Inflammatory conditions

15% of UC patients,

1% of chron’s patients

Ischaemic

Radiation

Infectious

AIDS rarely

Hemorrhoids

–>50% have hemorrhoids,– but only 2%

of bleeding

attributed to them

Meckels Diverticulum

The most common cause of massive bleeding in pediatric patients

Evaluation

Same for UGI bleedIf unstable with hematochezia

need EGD 1st

Concealed Bleeding

Occasionally, a person with a LGIB will not present with any signs of internal bleeding.

A Diagnostic or pre-assessment: hypotension, tachycardia, angina, syncope, weakness, confusion, stroke, myocardial infarction/heart attack, and shock.

Laboratory test

Hemoglobin, hematocrit, and platelets Partial thromboplastin time (PTT) and INR

Diagnostics

ColonoscopyVideo capsule endoscopyIntraoperative endoscopy

Selective viseral angiography

Need >0.5 ml/min bleeding40-75% sensitive if bleeding at time

of exam

Tagged RBC scan

Can detect bleeding at 0.1 ml/min

Meckel’s scanInitial test for patients <30 years old

Enteroclysis

Ulcerations

Inflammation

CT scan

Tumors Inflammation Diverticuli

GI hemorrhage from unknown source

Only 2-5% are not upper or lower

Treatment

Endoscopy:

Theraputic Angiodysplasia polypectomy sites

Angiographic

– Selective embolization for poor surgical candidates

– Can lead to ischemic sites requiring later resection

SurgeryOngoing hemorrhage, >6 units ongoing transfusion requirement

Site selection

Intraoperative endoscopy

Segmental resection

لله الحمد