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BURGOS ALDERETE, J. Lower gastrointestinal hemorrhage: emergency room management. An. Fac. Cienc. Méd. (Asunción) [online]. 2015, vol.48, n.1, pp.13-22. ISSN 1816-8949.  https://doi.org/10.18004/anales/2015.048(01)13-022.

ABSTRACT INTRODUCTION: The lower gastrointestinal bleeding (LGIB) tends to be self-limiting: in an 80-85% of the cases ceases spontaneously. Predominant in the male, its mortality rate is from 5 to 10% approximately. The objective of this study was to describe the management of LGIB at the First Chair of Clinical Surgery, ROOM 10 of the Hospital de Clinics from January 1997 to January 2010. SUBJECTS AND METHODS: An observational, descriptive, cross sectional and temporarily retrospective study with analytical component was conducted on patients with lower gastrointestinal bleeding who looked for medical attention at the Emergency Room of the First Chair of Clinical Surgery, ROOM 10 of the Hospital de Clinics. The study included patients of both genders, over 50 years with lower gastrointestinal bleeding, patients who were admitted by Emergency and were hospitalized at the First Chair of Clinical Surgery, ROOM 10 of the Hospital de Clinics from January 1997 to January 2010, patients with acute colon condition, patients without colonoscopy, patients with complete record. Patients were excluded from those younger than 50 years, patients who deceased without any treatment, patients with incomplete medical record. Non-probabilistic sample of consecutive cases. The variables were age and gender, reason for consultation, hemoglobin level, diagnosis of income, signs and symptoms, initial management, auxiliary means of diagnosis, treatment instituted, pathological anatomy, complications of the procedure, mortality. RESULTS: The study included 124 patients with lower gastrointestinal bleeding, of which 63% were female and 37% male. The most frequently (39%) between 50 and 59 years. 95% of patients consulted for rectorrhagia and 5% for melaena. Accompanying symptoms, 21% had pain in the left side of the iliac fossa, 12% had paleness, and 8%, abdominal distension. Admission hemoglobin level between 6-13 mg% (median = 9.8). On admission, the DRE allowed to check blood in all patients.Laboratory analysis were performed in all patients, 44 patients had a barium enema, 6 patients had a proctosigmoidoscopy and both procedures were performed in 5 patients. 69 were not practiced any auxiliary means of diagnosis. The 124 patients who were hospitalized at the First Chair of Clinical Surgery, ROOM 10 of the Hospital de Clinics received medical treatment, 26% of the patients required emergency surgery for persistent (n = 31) or massive bleeding (n = 22). The procedures performed in the emergency room were: subtotal colectomy with ileostomy, with end-to-end anastomosis in 42% patients, left colectomy with colostomy and closure of distal stump in 34%, right colectomy with ileostomy and anal fistula (13%) and Hartmann’s procedure in 11%. DISCUSSION: 1.- The causes of lower gastrointestinal bleeding (LGIB) in patients who consulted the Emergency Room of the First Chair of Clinical Surgery, ROOM 10 of the Hospital de Clinics during the period from January 1997 to January 2010 were: diverticular disease of the colon 62% of cases, 38% of patients went to the outpatient clinic for the corresponding study. 2.- The auxiliary diagnosis methods used during emergency hospitalization were the digital rectal examination, proctosigmoidoscopy and barium enema. Failed to perform endoscopic and angiographic studies. 3.- All patients received medical treatment, resulting satisfactory in 70 patients. Emergency surgery was performed in 53 patients with persistent or massive bleeding from the LGIB. 4.- In the 53 patients who underwent emergency surgery, diagnosis made by anatomopathological study, evidenced diverticular disease of the colon (EDC) as a cause of the LGIB. 5.- In this work, a morbidity of 17% and a mortality rate of 3% were determined. 6.- There was low correlation in the studied variables such as age, hemoglobin value, type of surgery versus sex, type of complications and demise, not reaching significance level in any of the analyzed interrelations. Key Words: Lower gastrointestinal hemorrhage; Treatment; Emergency

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