Surgical options in lower gastrointestinal bleeding

Although 80% to 90% of massive lower gastrointestinal (GI) hemorrhages abate spontaneously, emergency surgery is often necessary in the other 20%. Indications for surgery include persistent hypotension, the transfusion of 4 to 6 units of blood in a 24-hour period, or recurrent bleeding. There is an increased mortality if greater then 10 units of blood are transfused. The source of bleeding is localized by diagnostic testing in 50% to 90% of patients with lower GI hemorrhage. Segmental resection of the colon can then be performed with a 10% mortality rate and a 4% incidence of rebleeding. When a bleeding source is not localized, subtotal colectomy is the procedure of choice with a 2% rate of rebleeding but an increased mortality rate of up to 21.8%. Much of the increase in mortality may be related to delay in surgery and excessive transfusion before surgery. Under certain circumstances, a case can be made for a blind extended right hemicolectomy because of its lower mortality.