NMS. Casos Clínicos

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Chapter 8 ♦ Lower Gastrointestinal Disorders

Early blush indicative of bleeding site

Figure 8-40: Red blood cell scan showing hemorrhage at the area of diverticulosis. Bottom center: Accumulation of blood (small arrows) in a presumed bleeding site. Blood traveling distally in the colonic lumen (large arrows). Q: What operation is appropriate? A: Before induction of anesthesia takes place, it is necessary to be certain that resuscitation is adequate . Based on the location, either a left or a right hemicolectomy to remove the bleeding source is appropriate; this is a preoperative decision . It is not recommended that a surgeon try to be too precise and remove only the site of bleeding, such as a diver- ticulum or a particular segment of bowel; this is associated with a high rebleeding rate. It is still necessary to explore the abdomen to be certain that there is no other significant SAMPLE Most surgeons would take this patient urgently to the operating room . It is critical to identify the probable bleeding site prior to proceeding to the operating room. Otherwise, the surgeon does not know which portion of the colon to remove. You have decided that operative intervention is necessary.