Tratamiento quirúrgico de la hemorragia del tubo digestivo bajo. Experiencia en el Instituto Nacional de Ciencias MÚdicas y Nutrición Salvador Zubirán / Surgical treatment of lower digestive tract hemorrhage. Experience at the Instituto Nacional de Ciencias MÚdicas y Nutrición Salvador Zubirán

RESUMO

BACKGROUND: Lower gastrointestinal bleeding is usually self-limiting in about 80 of cases; however, surgical treatment may be required in selected cases. Preoperative precise identification of the bleeding source is crucial for a successful outcome. OBJECTIVE: To determine the most frequent diagnoses, as well as short and long-term results in a series of patients who underwent a surgical procedure for lower gastrointestinal bleeding. MATERIAL AND METHODS: Retrospective analysis of 39 patients operated upon for lower gastrointestinal bleeding from 1979 through 1997 in a referral center. Demographic data, history, physical examination, laboratory tests, resuscitative measures, preoperative work-up for identification of bleeding source, definitive cause of bleeding, surgical procedure, operative morbidity and mortality, as well as long-term status and recurrence of bleeding were recorded. RESULTS: There were 54 women and 46 men. Mean age was 56 years (range, 15-92). Most patients presented hematochezia (69). Colonoscopy was the most used diagnostic procedure (69). The bleeding source was located in 90 of patients. Diverticular disease was the most frequent cause of bleeding. A segmental bowel resection was the treatment in 97 of cases. Morbidity was 23 with 18 of mortality. Recurrence occurred in 9 of survivors. CONCLUSIONS: Morbidity and mortality were high. Patients who require a surgical operation should be carefully selected and evaluated with a complete work-up to determine the site and cause of bleeding.