eMedicine Specialties > General Surgery > Colorectal

Lower Gastrointestinal Bleeding, Surgical Treatment: Multimedia

Author: Burt Cagir, MD, FACS, Assistant Professor of Surgery, State University of New York, Upstate Medical Center; Consulting Staff, Director of Surgical Research, Robert Packer Hospital; Associate Program Director, Department of Surgery, Guthrie Clinic
Coauthor(s): Elizabeth Cirincione, MD, Director of Colon and Rectal Surgery, Department of Surgery, Nassau University Medical Center
Contributor Information and Disclosures

Updated: Oct 29, 2009

Multimedia

Types of lower gastrointestinal (GI) bleeding.Media file 1: Types of lower gastrointestinal (GI) bleeding.
Types of lower gastrointestinal (GI) bleeding.

Types of lower gastrointestinal (GI) bleeding.

Algorithm for massive lower gastrointestinal (GI)...Media file 2: Algorithm for massive lower gastrointestinal (GI) bleeding.
Algorithm for massive lower gastrointestinal (GI)...

Algorithm for massive lower gastrointestinal (GI) bleeding.

More on Lower Gastrointestinal Bleeding, Surgical Treatment

Overview: Lower Gastrointestinal Bleeding, Surgical Treatment
Workup: Lower Gastrointestinal Bleeding, Surgical Treatment
Treatment: Lower Gastrointestinal Bleeding, Surgical Treatment
Follow-up: Lower Gastrointestinal Bleeding, Surgical Treatment
Multimedia: Lower Gastrointestinal Bleeding, Surgical Treatment
References
Further Reading

References

  1. Baum S, Nusbaum M, Blakemore WS, et al. The preoperative radiographic demonstration of intra-abdominal bleeding from undetermined sites by percutaneous selective celiac and superior mesenteric arteriography. Surgery. Nov 1965;58(5):797-805. [Medline].

  2. Rösch J. Gray RK. Grollman JH Jr. et al. Selective arterial drug infusions in the treatment of acute gastrointestinal bleeding. A preliminary report. Gastroenterology. 1971;59(3):341-9.

  3. Gayer C, Chino A, Lucas C, et al. Acute lower gastrointestinal bleeding in 1,112 patients admitted to an urban emergency medical center. Surgery. Oct 2009;146(4):600-6; discussion 606-7. [Medline].

  4. Half E, Bercovich D, Rozen P. Familial adenomatous polyposis. Orphanet J Rare Dis. Oct 12 2009;4(1):22. [Medline].

  5. Ng DA, Opelka FG, Beck DE, et al. Predictive value of technetium Tc 99m-labeled red blood cell scintigraphy for positive angiogram in massive lower gastrointestinal hemorrhage. Dis Colon Rectum. Apr 1997;40(4):471-7. [Medline].

  6. Schmidt KG, Rasmussen JW, Grove O, et al. The use of indium-111-labelled platelets for scintigraphic localization of gastrointestinal bleeding, with special reference to occult bleeding. Scand J Gastroenterol. May 1986;21(4):407-14. [Medline].

  7. Mole DJ, Hughes SJ, Khosraviani K. 111Indium-labelled red-cell scintigraphy to detect intermittent gastrointestinal bleeding from synchronous small- and large-bowel adenocarcinomas. Eur J Gastroenterol Hepatol. Aug 2004;16(8):795-9. [Medline].

  8. Sabharwal R, Vladica P, Chou R, et al. Helical CT in the diagnosis of acute lower gastrointestinal haemorrhage. Eur J Radiol. May 2006;58(2):273-9. [Medline].

  9. Frattaroli FM, Casciani E, Spoletini D, et al. Prospective study comparing multi-detector row CT and endoscopy in acute gastrointestinal bleeding. World J Surg. Oct 2009;33(10):2209-17. [Medline].

  10. Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg. Nov 1986;204(5):530-6. [Medline].

  11. Ryan MJ, Key SM, Dumbleton SA, MD, et al. Nonlocalized Lower Gastrointestinal Bleeding: Provocative Bleeding Studies with Intraarterial tPA, Heparin, and Tolazoline. J Vasc Interv Radiol. 2001;12:1273–77.

  12. Widlus DM, Salis AI. Reteplase provocative visceral arteriography. J Clin Gastroenterol. Oct 2007;41(9):830-3. [Medline].

  13. Frodsham A, Berkmen T, Ananian C, et al. Initial experience using N-butyl cyanoacrylate for embolization of lower gastrointestinal hemorrhage. J Vasc Interv Radiol. Oct 2009;20(10):1312-9. [Medline].

  14. Rosenkrantz H, Bookstein JJ, Rosen RJ, et al. Postembolic colonic infarction. Radiology. Jan 1982;142(1):47-51. [Medline].

  15. Kuo WT, Lee DE, Saad WE, et al. Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol. Dec 2003;14(12):1503-9. [Medline].

  16. Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. Gastroenterology. Dec 1988;95(6):1569-74. [Medline].

  17. Fusaroli P, Grillo A, Zanarini S, et al. Usefulness of a second endoscopic arm to improve therapeutic endoscopy in the lower gastrointestinal tract. Preliminary experience - a case series. Endoscopy. Oct 2 2009;[Medline].

  18. Athanasoulis CA, Baum S, Rosch J, et al. Mesenteric arterial infusions of vasopressin for hemorrhage from colonic diverticulosis. Am J Surg. Feb 1975;129(2):212-6. [Medline].

  19. Casarella WJ, Galloway SJ, Taxin RN, et al. "Lower" gastrointestinal tract hemorrhage: new concepts based on arteriography. Am J Roentgenol Radium Ther Nucl Med. Jun 1974;121(2):357-68. [Medline].

  20. Drapanas T, Pennington DG, Kappelman M, et al. Emergency subtotal colectomy: preferred approach to management of massively bleeding diverticular disease. Ann Surg. May 1973;177(5):519-26. [Medline].

  21. Emslie JT, Zarnegar K, Siegel ME, et al. Technetium-99m-labeled red blood cell scans in the investigation of gastrointestinal bleeding. Dis Colon Rectum. Jul 1996;39(7):750-4. [Medline].

  22. Ernst O, Bulois P, Saint-Drenant S, et al. Helical CT in acute lower gastrointestinal bleeding. Eur Radiol. Jan 2003;13(1):114-7. [Medline].

  23. Ferrant A, Dehasque N, Leners N, et al. Scintigraphy with In-111-labeled red cells in intermittent gastrointestinal bleeding. J Nucl Med. Sep 1980;21(9):844-5. [Medline].

  24. Gordon PH, Nivatvongs S. Complications of colonic disease and their management. In: Principles and Practice of Surgery for the Colon, Rectum, and Anus. 2nd ed. 1992:1263-1278.

  25. Gordon RL, Ahl KL, Kerlan RK, et al. Selective arterial embolization for the control of lower gastrointestinal bleeding. Am J Surg. Jul 1997;174(1):24-8. [Medline].

  26. Guy GE, Shetty PC, Sharma RP, et al. Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particles. AJR Am J Roentgenol. Sep 1992;159(3):521-6. [Medline].

  27. Hammond KL, Beck DE, Hicks TC, et al. Implications of negative technetium 99m-labeled red blood cell scintigraphy in patients presenting with lower gastrointestinal bleeding. Am J Surg. Mar 2007;193(3):404-7; discussion 407-8. [Medline].

  28. Hemingway AP, Allison DJ. Colonic embolisation: useful but caution required. Gut. Jul 1998;43(1):4-5. [Medline].

  29. Kouraklis G, Misiakos E, Karatzas G, et al. Diagnostic approach and management of active lower gastrointestinal hemorrhage. Int Surg. Apr-Jun 1995;80(2):138-40. [Medline].

  30. Koziara FJ, Brodmerkel GJ, Boylan JJ, et al. Bleeding from polypoid colonic arteriovenous malformations. Am J Gastroenterol. Mar 1996;91(3):584-6. [Medline].

  31. Ledermann HP, Schoch E, Jost R, et al. Superselective coil embolization in acute gastrointestinal hemorrhage: personal experience in 10 patients and review of the literature. J Vasc Interv Radiol. Sep-Oct 1998;9(5):753-60. [Medline].

  32. Leitman IM, Paull DE, Shires GT 3rd. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg. Feb 1989;209(2):175-80. [Medline].

  33. Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. Mar 1997;92(3):419-24. [Medline].

  34. Macari M, Chandarana H, Balthazar E, et al. Intestinal ischemia versus intramural hemorrhage: CT evaluation. AJR Am J Roentgenol. Jan 2003;180(1):177-84. [Medline].

  35. Miller FH, Hwang CM. An initial experience: using helical CT imaging to detect obscure gastrointestinal bleeding. Clin Imaging. Jul-Aug 2004;28(4):245-51. [Medline].

  36. Nicholson AA, Ettles DF, Hartley JE, et al. Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage. Gut. Jul 1998;43(1):79-84. [Medline].

  37. Parkes BM, Obeid FN, Sorensen VJ, et al. The management of massive lower gastrointestinal bleeding. Am Surg. Oct 1993;59(10):676-8. [Medline].

  38. Ryan P, Styles CB, Chmiel R. Identification of the site of severe colon bleeding by technetium-labeled red-cell scan. Dis Colon Rectum. Mar 1992;35(3):219-22. [Medline].

  39. Rösch J, Dotter CT, Brown MJ. Selective arterial embolization. A new method for control of acute gastrointestinal bleeding. Radiology. Feb 1972;102(2):303-6. [Medline].

  40. Udén P, Jiborn H, Jonsson K. Influence of selective mesenteric arteriography on the outcome of emergency surgery for massive, lower gastrointestinal hemorrhage. A 15-year experience. Dis Colon Rectum. Sep 1986;29(9):561-6. [Medline].

  41. Uflacker R. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding. Acta Radiol. Jul-Aug 1987;28(4):425-30. [Medline].

  42. Vernava AM, Longo WE, Virgo KS. A nationwide study of the incidence and etiology of lower gastrointestinal bleeding. Surg Res Commun. 1996;18:113-120.

  43. Yamaguchi T, Yoshikawa K. Enhanced CT for initial localization of active lower gastrointestinal bleeding. Abdom Imaging. Sep-Oct 2003;28(5):634-6. [Medline].

Further Reading

Clinical guidelines:
ACR Appropriateness Criteria® left lower quadrant pain. American College of Radiology - Medical Specialty Society. 1996 (revised 2008). 5 pages. NGC:006988

ACR Appropriateness Criteria® treatment of acute nonvariceal gastrointestinal tract bleeding. American College of Radiology - Medical Specialty Society. 2006. 6 pages. NGC:005537

ASGE guideline: the role of endoscopy in the patient with lower-GI bleeding. American Society for Gastrointestinal Endoscopy - Medical Specialty Society. 2005 Nov. 5 pages. NGC:004584

Practice parameters for the management of hemorrhoids (revised). American Society of Colon and Rectal Surgeons - Medical Specialty Society. 1993 (revised 2005 Feb). 6 pages. NGC:004337

Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). American Society of Colon and Rectal Surgeons - Medical Specialty Society. 1996 (revised 2005 Jul). 6 pages. NGC:004432

Clinical trials:
A Study To Investigate The Safety And Efficacy Of CP- 690,550 In Patients With Moderate And Severe Ulcerative Colitis.

Mechanistic Randomized Controlled Trial (RCT) of Mesalazine in Symptomatic Diverticular Disease

Keywords

lower gastrointestinal bleeding, gastrointestinal bleeding, rectal bleeding, colectomy, gastrointestinal endoscopy, gastrointestinal bleed, lower GI bleeding, rectal hemorrhage, lower diverticular hemorrhage, diverticular bleeding, diverticulosis, anorectal diseases, inflammatory bowel disease, IBD, angiodysplasias, small bowel diverticulosis

Contributor Information and Disclosures

Author

Burt Cagir, MD, FACS, Assistant Professor of Surgery, State University of New York, Upstate Medical Center; Consulting Staff, Director of Surgical Research, Robert Packer Hospital; Associate Program Director, Department of Surgery, Guthrie Clinic
Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, and Society for Surgery of the Alimentary Tract
Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth Cirincione, MD, Director of Colon and Rectal Surgery, Department of Surgery, Nassau University Medical Center
Elizabeth Cirincione, MD is a member of the following medical societies: American College of Surgeons and American Society of Colon and Rectal Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University
Marc D Basson, MD, PhD, MBA is a member of the following medical societies: American College of Surgeons and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael A Grosso, MD, Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital
Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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