Localizing the source of severe lower gastrointestinal (GI) bleeding is often difficult but is important to plan the extent of colonic resection.
Dr Saleh Abbas and colleagues from New Zealand audited the Auckland Hospital experience of selective angiography in localizing lower GI bleeding.
Patients admitted to Auckland Hospital with rectal bleeding and who subsequently had angiography were evaluated.
The research team reviewed clinical notes and radiological results of 88 patients during a 7-year period from 1997 to 2003.
The researchers collected data on demographic details, haemodynamic parameters, and change in haemoglobin level.
Data on the requirement of blood transfusion within 24 hour before the procedure, site of the bleeding and pathology was also obtained.
| A useful clinical indicator for positive angiography was haemodynamic instability
|Australian and New Zealand Journal of Surgery |
The team found that the site of bleeding was localized in 51% of patients.
Of these 38 patients, 30 had bleeding in the right colon or small bowel and 8 in the left colon.
Positive localization correlated with haemodynamic instability, and drop in haemoglobin level of 50 or more from previous admission.
The researchers also noted that transfusion requirement of 5 or more units of blood within 24 hours correlated with positive localization.
The team used logistic regression analysis to predict accurate localization.
Transfusion requirement of 5 or more units to achieve haemodynamic stability was the most powerful predictor of accurate localization.
Dr Abbas' team commented, “Catheter angiography for acute lower GI bleeding will successfully localize a point of bleeding in approximately 50% of patients.
“The most useful clinical indicator for positive angiography was haemodynamic instability particularly in those who require transfusion of 5 or more units of blood to achieve haemodynamic stability.”