Abdominal colectomy offers safe management for massive lower GI bleed

Preoperative localization of lower gastrointestinal (LGI) bleeding has been advocated on the presumption that lower morbidity and mortality are associated with limited colonic resection versus abdominal colectomy. However, extensive preoperative evaluation, especially when negative, may unnecessarily delay surgical therapy in the actively hemorrhaging patient. The purpose of this study was to analyze the mortality and morbidity associated with total abdominal colectomy (TAC) versus limited colonic resection (LIM), when performed for massive LGI hemorrhage. Sixty-one patients admitted for massive LGI bleeding (≥1 unit packed red blood cells (PRBCs) transfused preoperatively) over a 5-year period were analyzed. The following data was collected; preop PRBCs; total PRBCs; Apache score; age; resection type (LIM {n = 42} versus TAC {n = 19}); time elapsed before surgery; morbidity; and mortality. Patients in the TAC group received similar amounts of preoperative (4.1 ± 0.8 units) and total (6.6 ± 1.3 units) blood transfusions compared to the LIM group (3.3 ± 0.4 units and 5.3 ± 0.6 units). Overall, more time elapsed before surgery in the LIM group (95.4 ± 13.0 hrs) compared with the TAC group (73.7 ± 22.2 hrs) (P < 0.05 Student's t test). There was no significant difference in Apache score, age, or morbidity. Mortality rates were similar between the two groups (LIM 15%, TAC 6%). There was no instance of intractable diarrhea postoperatively in either group. The results indicate that TAC is a safe method of treating massive LGI hemorrhage. Attempts at localizing the source of bleeding, although very helpful in focusing surgical therapy, should not unduly delay definitive surgical therapy based on the misconception that TAC is associated with significantly more morbidity.