Management strategies of acute lower gastrointestinal bleeding (ALGIB) of our departement. Results of the last two years (2004–2005)

Object: Acute lower gastrointestinal bleeding (ALGIB) is a common and often serious clinical condition; it is a frequent cause of hospital admissions. The optimal management of ALGIB is controversial. The aim of the study was to evaluate the usefulness of the different diagnostic procedures, and to offer a practical diagnostic and therapeutic algorithm.

Methods: The patents were treated in the subintensive care unit of our dept. Pts underwent clinical evaluation and stabilization. Intensive monitoring and care has been established if needed before diagnostic or specific therapeutic intervention. According to the severity of bleeding emergency or elective diagnostic algorithm was chosen. Colonoscopy was performed in every case, except pts with life-threatening bleeding. Our choice was angiography in these cases. We applied rapid oral purge with polyethylene glycol via NG-tube before urgent and early colonoscopy in severe bleeding. NG-tube placement and/or upper endoscopy had been used if signs and symptoms of shock or severe blood loss were present to look for an upper-GI source of bleeding. In pts with obscure bleeding radionuclide imaging or small bowel evaluation (double-balloon enteroscopy/capsule endoscopy) was performed.

Results: 77 pts were treated because of ALGIB in two years (M/F: 40/37, mean age 69yrs, mortality 7,8% (4 pts/5,2%/were in terminal state at admission). Bleeding sources: diverticular disease 27%, colonic neoplasia, and post polypectomy bleeding 27%, colonic vascular ectasia 3%, colitis (ischaemia, IBD, radiation proctopathy, NSAID ulceration) 10%, anorectal causes 10%, small bowel sites 7%. Bleeding source was unknown in 16%. Injection therapy was performed in 4, polypectomy in 13 cases. Urgent surgery was done in 6, elective surgery in 10 cases. Intraoperative endoscopy was done in 4 cases.

Conclusion: The most common sources of ALGIB were diverticulosis and colorectal neoplasia. The most important diagnostic method was colonoscopy, which was performed effectively even in severe bleeding after nasogastric purge lavage. In the most severe cases angiography is the most valuable diagnostic method.