Current Treatment of Lower Gastrointestinal Hemorrhage

Tal Raphaeli; Raman Menon

doi:10.1055/s-0032-1329393

Clinics in Colon and Rectal Surgery, Table of Contents

Clin Colon Rectal Surg 2012; 25(04): 219-227
DOI: 10.1055/s-0032-1329393

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Current Treatment of Lower Gastrointestinal Hemorrhage

Tal Raphaeli

¹Swedish Colon and Rectal Clinic, Seattle, Washington

,

Raman Menon

¹Swedish Colon and Rectal Clinic, Seattle, Washington

› Author Affiliations

Abstract

Massive lower gastrointestinal bleeding is a significant and expensive problem that requires methodical evaluation, management, and treatment. After initial resuscitation, care should be taken to localize the site of bleeding. Once localized, lesions can then be treated with endoscopic or angiographic interventions, reserving surgery for ongoing or recurrent bleeding.

Keywords

lower gastrointestinal hemorrhage - angiography - colonoscopy - gastrointestinal hemorrhage: surgery - radionuclide scintigraphy

Full Text

References

References
1 Parker DR, Luo X, Jalbert JJ, Assaf AR. Impact of upper and lower gastrointestinal blood loss on healthcare utilization and costs: a systematic review. J Media Econ 2011; 14 (3) 279-287
2 Whelan CT, Chen C, Kaboli P, Siddique J, Prochaska M, Meltzer DO. Upper versus lower gastrointestinal bleeding: a direct comparison of clinical presentation, outcomes, and resource utilization. J Hosp Med 2010; 5 (3) 141-147
3 Prakash C, Zuckerman GR. Acute small bowel bleeding: a distinct entity with significantly different economic implications compared with GI bleeding from other locations. Gastrointest Endosc 2003; 58 (3) 330-335
4 Zhao Y, Encinosa W. Hospitalizations for gastrointestinal bleeding in 1998 and 2006. Healthcare Cost and Utilization Project (HCUP) Statistical Brief #5. Rockville, MD: Agency for Healthcare Research and Quality; 2008
5 Farrell JJ, Friedman LS. Gastrointestinal bleeding in the elderly. Gastroenterol Clin North Am 2001; 30 (2) 377-407 , viii.
6 McGuire Jr HH, Haynes Jr BW. Massive hemorrhage for diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in fifty cases. Ann Surg 1972; 175 (6) 847-855
7 McGuire Jr HH. Bleeding colonic diverticula. A reappraisal of natural history and management. Ann Surg 1994; 220 (5) 653-656
8 Potter GD, Sellin JH. Lower gastrointestinal bleeding. Gastroenterol Clin North Am 1988; 17 (2) 341-356
9 Matsagas MI, Fatouros M, Koulouras B, Giannoukas AD. Incidence, complications, and management of Meckel's diverticulum. Arch Surg 1995; 130 (2) 143-146
10 Mackey WC, Dineen P. A fifty year experience with Meckel's diverticulum. Surg Gynecol Obstet 1983; 156 (1) 56-64
11 Ymaguchi M, Takeuchi S, Awazu S. Meckel's diverticulum. Investigation of 600 patients in Japanese literature. Am J Surg 1978; 136 (2) 247-249
12 Yahchouchy EK, Marano AF, Etienne JC, Fingerhut AL. Meckel's diverticulum. J Am Coll Surg 2001; 192 (5) 658-662
13 Elitsur Y, Teitelbaum JE, Rewalt M, Nowicki M. Clinical and endoscopic data in juvenile polyposis syndrome in preadolescent children: a multicenter experience from the United States. J Clin Gastroenterol 2009; 43 (8) 734-736
14 Robert JR, Sachar DB, Greenstein AJ. Severe gastrointestinal hemorrhage in Crohn's disease. Ann Surg 1991; 213 (3) 207-211
15 Robert JH, Sachar DB, Aufses Jr AH, Greenstein AJ. Management of severe hemorrhage in ulcerative colitis. Am J Surg 1990; 159 (6) 550-555
16 Zuckerman GR, Prakash C. Acute lower intestinal bleeding: part I: clinical presentation and diagnosis. Gastrointest Endosc 1998; 48 (6) 606-617
17 Reinus JF, Brandt LJ. Vascular ectasias and diverticulosis. Common causes of lower intestinal bleeding. Gastroenterol Clin North Am 1994; 23 (1) 1-20
18 McGuire Jr HH, Haynes Jr BW. Massive hemorrhage for diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in fifty cases. Ann Surg 1972; 175 (6) 847-855
19 Wong SK, Ho YH, Leong AP, Seow-Choen F. Clinical behavior of complicated right-sided and left-sided diverticulosis. Dis Colon Rectum 1997; 40 (3) 344-348
20 McGuire Jr HH. Bleeding colonic diverticula. A reappraisal of natural history and management. Ann Surg 1994; 220 (5) 653-656
21 Casarella WJ, Kanter IE, Seaman WB. Right-sided colonic diverticula as a cause of acute rectal hemorrhage. N Engl J Med 1972; 286 (9) 450-453
22 Meyers MA, Alonso DR, Gray GF, Baer JW. Pathogenesis of bleeding colonic diverticulosis. Gastroenterology 1976; 71 (4) 577-583
23 Boley SJ, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S. On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology 1977; 72 (4 Pt 1) 650-660
24 King RM, Pluth JR, Giuliani ER. The association of unexplained gastrointestinal bleeding with calcific aortic stenosis. Ann Thorac Surg 1987; 44 (5) 514-516
25 Imperiale TF, Ransohoff DF. Aortic stenosis, idiopathic gastrointestinal bleeding, and angiodysplasia: is there an association? A methodologic critique of the literature. Gastroenterology 1988; 95 (6) 1670-1676
26 Olearchyk AS. Heyde's syndrome. J Thorac Cardiovasc Surg 1992; 103 (4) 823-824
27 Batur P, Stewart WJ, Isaacson JH. Increased prevalence of aortic stenosis in patients with arteriovenous malformations of the gastrointestinal tract in Heyde syndrome. Arch Intern Med 2003; 163 (15) 1821-1824
28 Breen E, Murray J. Pathophysiology and natural history of lower gastrointestinal bleeding. Semin Colon Rectal Surg 1997; 8: 128-138
29 Rosen L, Bub DS, Reed III JF, Nastasee SA. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum 1993; 36 (12) 1126-1131
30 Zuckerman GR, Prakash C. Acute lower intestinal bleeding. Part II: etiology, therapy, and outcomes. Gastrointest Endosc 1999; 49 (2) 228-238
31 Laine L, Shah A. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol 2010; 105 (12) 2636-2641 , quiz 2642
32 Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. Gastroenterology 1988; 95 (6) 1569-1574
33 Ozdil B, Akkiz H, Sandikci M, Kece C, Cosar A. Massive lower gastrointestinal hemorrhage secondary to rectal hemorrhoids in elderly patients receiving anticoagulant therapy: case series. Dig Dis Sci 2010; 55 (9) 2693-2694
34 Peter P, Deyhle P, Brändli H , et al. [Endoscopic diagnosis of acute perianal hemorrhage]. Schweiz Med Wochenschr 1976; 106 (26) 880-883
35 Green BT, Rockey DC, Portwood G , et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol 2005; 100 (11) 2395-2402
36 Caos A, Benner KG, Manier J , et al. Colonoscopy after Golytely preparation in acute rectal bleeding. J Clin Gastroenterol 1986; 8 (1) 46-49
37 Rossini FP, Ferrari A, Spandre M , et al. Emergency colonoscopy. World J Surg 1989; 13 (2) 190-192
38 Green BT, Rockey DC, Portwood G , et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol 2005; 100 (11) 2395-2402
39 Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. Gastroenterology 1988; 95 (6) 1569-1574
40 Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000; 342 (2) 78-82
41 Laine L. Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage. A prospective controlled trial. N Engl J Med 1987; 316 (26) 1613-1617
42 Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992; 102 (1) 139-148
43 Laine L, Shah A. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol 2010; 105 (12) 2636-2641 , quiz 2642
44 Strate LL. Lower GI bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am 2005; 34 (4) 643-664
45 Hoedema RE, Luchtefeld MA. The management of lower gastrointestinal hemorrhage. Dis Colon Rectum 2005; 48 (11) 2010-2024
46 Howarth DM. The role of nuclear medicine in the detection of acute gastrointestinal bleeding. Semin Nucl Med 2006; 36 (2) 133-146
47 Currie GM, Towers PA, Wheat JM. Improved detection and localization of lower gastrointestinal tract hemorrhage by subtraction scintigraphy: phantom analysis. J Nucl Med Technol 2006; 34 (3) 160-168
48 Alavi A, Dann RW, Baum S, Biery DN. Scintigraphic detection of acute gastrointestinal bleeding. Radiology 1977; 124 (3) 753-756
49 Hunter JM, Pezim ME. Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding. Am J Surg 1990; 159 (5) 504-506
50 Nicholson ML, Neoptolemos JP, Sharp JF, Watkin EM, Fossard DP. Localization of lower gastrointestinal bleeding using in vivo technetium-99m-labelled red blood cell scintigraphy. Br J Surg 1989; 76 (4) 358-361
51 Voeller GR, Bunch G, Britt LG. Use of technetium-labeled red blood cell scintigraphy in the detection and management of gastrointestinal hemorrhage. Surgery 1991; 110 (4) 799-804
52 Gunderman R, Leef J, Ong K, Reba R, Metz C. Scintigraphic screening prior to visceral arteriography in acute lower gastrointestinal bleeding. J Nucl Med 1998; 39 (6) 1081-1083
53 Nusbaum M, Baum S. Radiographic demonstration of unknown sites of gastrointestinal bleeding. Surg Forum 1963; 14: 374-375
54 Feldkamp T, Baumgart D, Elsner M , et al. Nephrotoxicity of iso-osmolar versus low-osmolar contrast media is equal in low risk patients. Clin Nephrol 2006; 66 (5) 322-330
55 Heinrich MC, Häberle L, Müller V, Bautz W, Uder M. Nephrotoxicity of iso-osmolar iodixanol compared with nonionic low-osmolar contrast media: meta-analysis of randomized controlled trials. Radiology 2009; 250 (1) 68-86
56 Zuckerman DA, Bocchini TP, Birnbaum EH. Massive hemorrhage in the lower gastrointestinal tract in adults: diagnostic imaging and intervention. AJR Am J Roentgenol 1993; 161 (4) 703-711
57 Leitman IM, Paull DE, Shires III GT. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg 1989; 209 (2) 175-180
58 Nath RL, Sequeira JC, Weitzman AF, Birkett DH, Williams Jr LF. Lower gastrointestinal bleeding. Diagnostic approach and management conclusions. Am J Surg 1981; 141 (4) 478-481
59 Koval G, Benner KG, Rösch J, Kozak BE. Aggressive angiographic diagnosis in acute lower gastrointestinal hemorrhage. Dig Dis Sci 1987; 32 (3) 248-253
60 Rösch J, Kozak BE, Keller FS, Dotter CT. Interventional angiography in the diagnosis of acute lower gastrointestinal bleeding. Eur J Radiol 1986; 6 (2) 136-141
61 Kim CY, Suhocki PV, Miller Jr MJ, Khan M, Janus G, Smith TP. Provocative mesenteric angiography for lower gastrointestinal hemorrhage: results from a single-institution study. J Vasc Interv Radiol 2010; 21 (4) 477-483
62 Ryan JM, Key SM, Dumbleton SA, Smith TP. Nonlocalized lower gastrointestinal bleeding: provocative bleeding studies with intraarterial tPA, heparin, and tolazoline. J Vasc Interv Radiol 2001; 12 (11) 1273-1277
63 Bloomfeld RS, Smith TP, Schneider AM, Rockey DC. Provocative angiography in patients with gastrointestinal hemorrhage of obscure origin. Am J Gastroenterol 2000; 95 (10) 2807-2812
64 Jaeckle T, Stuber G, Hoffmann MHK, Jeltsch M, Schmitz BL, Aschoff AJ. Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT. Eur Radiol 2008; 18 (7) 1406-1413
65 Jain TP, Gulati MS, Makharia GK, Bandhu S, Garg PK. CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results. Clin Radiol 2007; 62 (7) 660-667
66 Yoon W, Jeong YY, Shin SS , et al. Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT. Radiology 2006; 239 (1) 160-167
67 Huprich JE, Fletcher JG, Alexander JA, Fidler JL, Burton SS, McCullough CH. Obscure gastrointestinal bleeding: evaluation with 64-section multiphase CT enterography—initial experience. Radiology 2008; 246 (2) 562-571
68 Al-Saeed O, Kombar O, Morsy M, Sheikh M. Sixty-four multi-detector computerised tomography in the detection of lower gastrointestinal bleeding: A prospective study. J Med Imaging Radiat Oncol 2011; 55 (3) 252-258
69 Ell C, Remke S, May A, Helou L, Henrich R, Mayer G. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy 2002; 34 (9) 685-689
70 Cuyle PJ, Schoofs N, Bossuyt P , et al. Single-centre experience on use of videocapsule endoscopy for obscure gastrointestinal bleeding in 120 consecutive patients. Acta Gastroenterol Belg 2011; 74 (3) 400-406
71 Lewis BS, Swain P. Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: results of a pilot study. Gastrointest Endosc 2002; 56 (3) 349-353
72 Arakawa D, Ohmiya N, Nakamura M , et al. Outcome after enteroscopy for patients with obscure GI bleeding: diagnostic comparison between double-balloon endoscopy and videocapsule endoscopy. Gastrointest Endosc 2009; 69 (4) 866-874
73 Hadithi M, Heine GDN, Jacobs MAJM, van Bodegraven AA, Mulder CJ. A prospective study comparing video capsule endoscopy with double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2006; 101 (1) 52-57
74 Ohmiya N, Yano T, Yamamoto H , et al. Diagnosis and treatment of obscure GI bleeding at double balloon endoscopy. Gastrointest Endosc 2007; 66 (3, Suppl) S72-S77
75 Fujimori S, Seo T, Gudis K , et al. Diagnosis and treatment of obscure gastrointestinal bleeding using combined capsule endoscopy and double balloon endoscopy: 1-year follow-up study. Endoscopy 2007; 39 (12) 1053-1058
76 Kamalaporn P, Cho S, Basset N , et al. Double-balloon enteroscopy following capsule endoscopy in the management of obscure gastrointestinal bleeding: outcome of a combined approach. Can J Gastroenterol 2008; 22 (5) 491-495
77 Pata C, Akyüz Ü, Erzın Y, Mercan A. Double-balloon enteroscopy: the diagnosis and management of small bowel diseases. Turk J Gastroenterol 2010; 21 (4) 353-359
78 Sfakianakis GN, Haase GM. Abdominal scintigraphy for ectopic gastric mucosa: a retrospective analysis of 143 studies. AJR Am J Roentgenol 1982; 138 (1) 7-12
79 Lin S, Suhocki PV, Ludwig KA, Shetzline MA. Gastrointestinal bleeding in adult patients with Meckel's diverticulum: the role of technetium 99m pertechnetate scan. South Med J 2002; 95 (11) 1338-1341
80 Green BT, Rockey DC. Lower gastrointestinal bleeding—management. Gastroenterol Clin North Am 2005; 34 (4) 665-678
81 Olmos JA, Marcolongo M, Pogorelsky V, Herrera L, Tobal F, Dávolos JR. Long-term outcome of argon plasma ablation therapy for bleeding in 100 consecutive patients with colonic angiodysplasia. Dis Colon Rectum 2006; 49 (10) 1507-1516
82 Naveau S, Aubert A, Poynard T, Chaput JC. Long-term results of treatment of vascular malformations of the gastrointestinal tract by neodymium YAG laser photocoagulation. Dig Dis Sci 1990; 35 (7) 821-826
83 Chak A, Koehler MK, Sundaram SN, Cooper GS, Canto MI, Sivak Jr MV. Diagnostic and therapeutic impact of push enteroscopy: analysis of factors associated with positive findings. Gastrointest Endosc 1998; 47 (1) 18-22
84 Askin MP, Lewis BS. Push enteroscopic cauterization: long-term follow-up of 83 patients with bleeding small intestinal angiodysplasia. Gastrointest Endosc 1996; 43 (6) 580-583
85 Rutgeerts P, Van Gompel F, Geboes K, Vantrappen G, Broeckaert L, Coremans G. Long term results of treatment of vascular malformations of the gastrointestinal tract by neodymium Yag laser photocoagulation. Gut 1985; 26 (6) 586-593
86 Jensen DM, Machicado GA. Colonoscopy for diagnosis and treatment of severe lower gastrointestinal bleeding. Routine outcomes and cost analysis. Gastrointest Endosc Clin N Am 1997; 7 (3) 477-498
87 Bloomfeld RS, Shetzline M, Rockey D. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000; 342 (21) 1608-1609 , author reply 1610–1611
88 Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000; 342 (2) 78-82
89 Hokama A, Uehara T, Nakayoshi T , et al. Utility of endoscopic hemoclipping for colonic diverticular bleeding. Am J Gastroenterol 1997; 92 (3) 543-546
90 Ohyama T, Sakurai Y, Ito M, Daito K, Sezai S, Sato Y. Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding. Digestion 2000; 61 (3) 189-192
91 Simpson PW, Nguyen MH, Lim JK, Soetikno RM. Use of endoclips in the treatment of massive colonic diverticular bleeding. Gastrointest Endosc 2004; 59 (3) 433-437
92 Baum S, Nusbaum M. The control of gastrointestinal hemorrhage by selective mesenteric arterial infusion of vasopressin. Radiology 1971; 98 (3) 497-505
93 Darcy M. Treatment of lower gastrointestinal bleeding: vasopressin infusion versus embolization. J Vasc Interv Radiol 2003; 14 (5) 535-543
94 Rösch J, Dotter CT, Brown MJ. Selective arterial embolization. A new method for control of acute gastrointestinal bleeding. Radiology 1972; 102 (2) 303-306
95 Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg 1986; 204 (5) 530-536
96 Uflacker R. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding. Acta Radiol 1987; 28 (4) 425-430
97 Rosenkrantz H, Bookstein JJ, Rosen RJ, Goff II WB, Healy JF. Postembolic colonic infarction. Radiology 1982; 142 (1) 47-51
98 Peck DJ, McLoughlin RF, Hughson MN, Rankin RN. Percutaneous embolotherapy of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 1998; 9 (5) 747-751
99 Kuo WT, Lee DE, Saad WEA, Patel N, Sahler LG, Waldman DL. Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 2003; 14 (12) 1503-1509
100 Ledermann HP, Schoch E, Jost R, Decurtins M, Zollikofer CL. Superselective coil embolization in acute gastrointestinal hemorrhage: personal experience in 10 patients and review of the literature. J Vasc Interv Radiol 1998; 9 (5) 753-760
101 Nicholson AA, Ettles DF, Hartley JE , et al. Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage. Gut 1998; 43 (1) 79-84
102 Ahmed TM, Cowley JB, Robinson G , et al. Long term follow-up of transcatheter coil embolotherapy for major colonic haemorrhage. Colorectal Dis 2010; 12 (10) 1013-1017
103 Schuetz A, Jauch KW. Lower gastrointestinal bleeding: therapeutic strategies, surgical techniques and results. Langenbecks Arch Surg 2001; 386 (1) 17-25
104 Bokhari M, Vernava AM, Ure T, Longo WE. Diverticular hemorrhage in the elderly—is it well tolerated?. Dis Colon Rectum 1996; 39 (2) 191-195
105 Billingham RP. The conundrum of lower gastrointestinal bleeding. Surg Clin North Am 1997; 77 (1) 241-252
106 Cussons PD, Berry AR. Comparison of the value of emergency mesenteric angiography and intraoperative colonoscopy with antegrade colonic irrigation in massive rectal haemorrhage. J R Coll Surg Edinb 1989; 34 (2) 91-93
107 Campbell WB, Rhodes M, Kettlewell MG. Colonoscopy following intraoperative lavage in the management of severe colonic bleeding. Ann R Coll Surg Engl 1985; 67 (5) 290-292
108 Flickinger EG, Stanforth AC, Sinar DR, MacDonald KG, Lannin DR, Gibson JH. Intraoperative video panendoscopy for diagnosing sites of chronic intestinal bleeding. Am J Surg 1989; 157 (1) 137-144
109 Desa LA, Ohri SK, Hutton KA, Lee H, Spencer J. Role of intraoperative enteroscopy in obscure gastrointestinal bleeding of small bowel origin. Br J Surg 1991; 78 (2) 192-195
110 Farner R, Lichliter W, Kuhn J, Fisher T. Total colectomy versus limited colonic resection for acute lower gastrointestinal bleeding. Am J Surg 1999; 178 (6) 587-591
111 Britt LG, Warren L, Moore III OF. Selective management of lower gastrointestinal bleeding. Am Surg 1983; 49 (3) 121-125
112 Parkes BM, Obeid FN, Sorensen VJ, Horst HM, Fath JJ. The management of massive lower gastrointestinal bleeding. Am Surg 1993; 59 (10) 676-678
113 Colacchio TA, Forde KA, Patsos TJ, Nunez D. Impact of modern diagnostic methods on the management of active rectal bleeding. Ten year experience. Am J Surg 1982; 143 (5) 607-610
114 Gianfrancisco JA, Abcarian H. Pitfalls in the treatment of massive lower gastrointestinal bleeding with “blind” subtotal colectomy. Dis Colon Rectum 1982; 25 (5) 441-445
115 Baker R, Senagore A. Abdominal colectomy offers safe management for massive lower GI bleed. Am Surg 1994; 60 (8) 578-581 , discussion 582
116 Bender JS, Wiencek RG, Bouwman DL. Morbidity and mortality following total abdominal colectomy for massive lower gastrointestinal bleeding. Am Surg 1991; 57 (8) 536-540 , discussion 540–541
117 Baker R, Senagore A. Abdominal colectomy offers safe management for massive lower GI bleed. Am Surg 1994; 60 (8) 578-581 , discussion 582
118 Eaton AC. Emergency surgery for acute colonic haemorrhage—a retrospective study. Br J Surg 1981; 68 (2) 109-112
119 Drapanas T, Pennington DG, Kappelman M, Lindsey ES. Emergency subtotal colectomy: preferred approach to management of massively bleeding diverticular disease. Ann Surg 1973; 177 (5) 519-526
120 Farrell JJ, Friedman LS. Review article: the management of lower gastrointestinal bleeding. Aliment Pharmacol Ther 2005; 21 (11) 1281-1298
121 Lee J, Costantini TW, Coimbra R. Acute lower GI bleeding for the acute care surgeon: current diagnosis and management. Scand J Surg 2009; 98 (3) 135-142
122 Billingham RP. The conundrum of lower gastrointestinal bleeding. Surg Clin North Am 1997; 77 (1) 241-252