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• W2085652512 abstract "Evaluar prospectivamente la eficacia de un protocolo de manejo (basado en angiografía y/o colonoscopia urgente) para localizar el foco de sangrado, y analizar la morbilidad y mortalidad de la cirugía urgente en la hemorragia digestiva baja grave(HDB). Se incluyeron todos los pacientes con HDB grave (inestabilidad persistente, hemorragia recidivante con transfusiones o sangrado mayor de 1.500 ml) durante un período de 77 meses. Se indicaron colonoscopia y/o angiografía visceral si el sangrado no era anorrectal en la exploración física. Se midió el riesgo quirúrgico con el índice ASA, y la comparación estadística se realizó con la prueba exacta de Fisher. Se trataron 40 pacientes con una mediana de edad de 75 años. El 65% de los pacientes sangraron por enfermedad diverticular o malformaciones arteriovenosas del colon. Se intervino a 35 pacientes, 32 de ellos por laparotomía: se realizaron 3 resecciones de intestino delgado, 5 intervenciones de recto, 5 colectomías totales, 18 colectomías segmentarias y una laparotomía exploradora. El 75% de las colonoscopias y el 68% de las angiografías localizaron el foco de sangrado. La mortalidad fue del 28%, principalmente por insuficiencia cardíaca, resangrado postoperatorio (11%) y dehiscencia de sutura (14%). La morbilidad y mortalidad se relacionaron estadísticamente con el índice ASA IV-V y con la cirugía urgente diferida a un segundo episodio de sangrado masivo. La angiografía urgente y la colonoscopia tras preparación mecánica rápida constituye una buena combinación para localizar el foco de HDB en la mayoría de los pacientes. Sin embargo, la gravedad de la HDB asociada a la edad y comorbilidades de esta población provoca una alta mortalidad, que sólo se podrá reducir mejorando aún más los cuidados cardiorrespiratorios y considerando de forma selectiva la realización de ostomías. To prospectively evaluate the efficacy of a management protocol (based on angiography and/or emergency colonoscopy) to locate the source of bleeding and to analyze morbidity and mortality in emergency surgery for severe lower gastrointestinal bleeding (LGB). All patients with severe LGB (persistent instability, recurrent hemorrhage with transfusions or bleeding greater than 1500 mL) during a 77-month period were included. Colonoscopy and/or visceral angiography were indicated if physical examination revealed bleeding not to be anorectal. Surgical risk was calculated using the American Society of Anesthesiology (ASA) index and statistical comparison was performed using Fisher's exact test. Forty patients were treated. The mean age was 75 years. In 65% of the patients bleeding was due to diverticular disease or arteriovenous malformations of the colon. Surgery was performed in 35 patients. Of these, laparotomic surgery was used in 32: 3 resections of the small intestine, 5 rectal interventions, 5 total colectomies, 18 subtotal colectomies and 1 exploratory laparotomy. Seventy-five percent of colonoscopies and 68% of angiographies located the source of bleeding. Mortality was 28%, mainly due to cardiac failure, postoperative rebleeding (11%) and wound dehiscence (14%). Morbidity and mortality were statistically related to ASA grade IV-V and with delay of emergency surgery to a second episode of massive bleeding. In most patients, emergency angiography and colonoscopy after rapid mechanical preparation constitutes an effective combination to locate the source of LGB. However, the severity of LGB associated with age and comorbidities in this population provokes high mortality, which can only be reduced by improving even further cardiorespiratory care and by selectively performing ostomies." @default.
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• W2085652512 date "2003-01-01" @default.
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• W2085652512 title "Eficacia de un protocolo de manejo de la hemorragia digestiva baja grave" @default.
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• W2085652512 doi "https://doi.org/10.1016/s0009-739x(03)72098-3" @default.
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