2005 Abstracts: Acute Lower Gastrointestinal Bleeding in An Urbanemergency Hospital: Findings and Outcomes in 657 Patients
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Acute Lower Gastrointestinal Bleeding in An Urbanemergency Hospital: Findings and Outcomes in 657 Patients
Choichi Sugawa, Jason M. Blocksom, Hiromi Ono, Charles E. Lucas, Wayne State University, Detroit, MI
Background: This study was performed to elucidate the etiology, effectiveness of diagnostic and therapeutic modalities, and outcomes in patients with severe acute lower gastrointestinal bleeding (LGIB).
Methods: A retrospective review of the medical records of 657 consecutive patients admitted to the surgical service of a single urban emergency hospital with LGIB requiring hospitalization from October 1987 to April 2000. There were 683 total admissions of these patients. Results: All patients underwent colonoscopy, 33.2% within 24 hours of admission. Most patients (67.1%) also had upper endoscopy. Fifty-two patients subsequently had barium enemas. Eight of 16 nuclide scans were positive. Upper GI/small bowel contrast studies were performed in 13 patients, all non-diagnostic. Arteriography was performed on 11 patients, with 5 positive results, none therapeutic. Hematochezia was the most frequent presentation (65%), followed by melena (11%), and maroon stools (10.5%). Diverticulosis (32.2%), hemorrhoids (27.1%), carcinoma (7.9%), and inflammatory bowel disease (5.7%) were the most common etiologies. The small bowel was the source in 5 patients. The diagnosis was elusive in 0.9% of patients. Half of readmissions were patients with diverticulosis. No surgical intervention was required in 76.5% of patients. Endoscopic control was obtained in 1.4%. Elective surgery was required in 17.3%, and emergent operation in 4.5% of patients. The overall mortality rate was 3.2%. Of 22 deaths, half with a primary diagnosis of diverticulosis, two were directly attributable to uncontrolled hemorrhage. Conclusion: In this urban setting, diverticulosis, hemorrhoids, carcinoma, and inflammatory bowel disease were the most common causes of severe acute LGIB. High recurrence of bleeding was noted with diverticulosis. Colonoscopy allows for diagnosis in the majority of patients with severe acute LGIB requiring hospitalization.
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