for Lower Gastrointestinal Tract Bleeding
Cohn SM, Moller BA, Zeig PM, et al
Angiography for Preoperative Evaluation in Patients with Lower Gastrointestinal are the Benefits Worth the Risks?
Arch Surg 133: 50-55, 1998
Whether angiography is beneficial in acute lower gastrointestinal [GI] tract bleeding to identify the site of bleeding and limit the extent of colonic resection is controversial. The impact of selective angiography on the clinical decision making in the management of lower GI tract bleeding and the associated morbidity of the procedure were determined retrospectively.
Records of 65 patients [37 women and 28 men] aged 27 to 93 years, undergoing 75 angiography procedures for evaluation of acute lower GI tract bleeding were reviewed. Associated medical problems, factors contributing to an increased risk of bleeding, and diagnostic methods were noted.
Nine patients had more than one angiography done. Angiographic studies were abnormal in 23 patients [35%] and 14 of these required surgery; normal in 42 patients and 8 required surgery. Of the 22 cases operated 11 had a hemicolectomy [9 on the basis of angiography], 10 had a subtotal colectomy and one had a small bowel tumor resection. Three hemicolectomy patients [two with normal angiographic findings] later required a subtotal colectomy. Six patients [3 had surgery] died. Seven patients [11%] had angiography related complications.
Angiography identified the specific site of bleeding only in 8 patients [12%]. Complication rate from angiography was 11%. Most patients [66%] did not require surgery including 9 out of 23 [39%] with abnormal angiographic findings.
Angiography does not give sufficient information on how to manage a patient with lower GI tract bleeding and carries a relatively high risk [11%] of complications.