Massive lower gastrointestinal bleeding in our department, the last 45 cases

Introduction: Lower gastrointestinal bleeding is a common cause for hospital admission accounting for 20 to 30 per 100.000 adults per year. Its spectrum of severity ranges from mild anal outlet bleeding to life-threatening, massive hemorrhage. Patients and methods: Last year 45 pts (20 men and 25 women, age: 28–99 ys) were admitted at our subintensive care unit with massive lower gastrointestinal bleeding. Although there are numerous possible etiologies, the most common causes of colonic bleeding were diverticulosis (n=15), colonic neoplasma (n=8) and postpolypectomy bleeding (n=5). There were also arteriovenous malformations (n=2), hemorrhoids (n=2), mesenteric thrombosis (n=2) and 1–1 case of anal fissure, rectal ulcer, irradiation proctitis, IBD, ischemic colitis and infective colitis. The origin remained unknown in 5 cases, but the bleeding stopped in all of them spontaneously. Colonoscopy was performed in most of the cases (42/45), 3 patients denied consent for colonoscopy. The median time from admission to endoscopy was within 24 hours (range: 1–168h). 20 pts had a history of coagulopathy, taking anticoagulants (5 pts were on acenokumarol, 3 pts on LMWH therapy) or antiplatelet therapy (16 pts used acetilsalicilic acid, 4 pts clopidogrel, one patient used ticlopidin). The use of nonsteroidal antiinflammatory drugs was found in 5 cases. Results: In the vast majority of cases (32/45), the bleeding ceased spontaneously, in 3 cases endoscopic therapy (hemostatic clips) was needed, in 10 cases the bleeding was solved by surgical procedures. Overall 6 pts died secondary to aging, severe heart, cerebrovascular or pulmonary diseases, renal and liver failure, 5 of them died after acute surgery. We did not loss any patients because of unsuccessful controll of bleeding. For the correction of coagulation deficiencies in sum 40 units of fresh frozen plasma were used in 22 cases. 155 units of packed red blood cells were transfused in 31 pts (range: 2–11 units/pts). In many cases (n=18) antibiotic treatment was used, mainly metronidazole, ceftriaxon or ciprofloxacin. During hospitalization recurrent bleeding occured in 12 cases (26.7%). Conclusion: The survival of patients admitted to our department for massive lower gastrointestinal bleeding, seems to be acceptable, thanks to our subintensive care unit and combined early endoscopic and supportive – pharmacologic treatment.