UTILITY OF LAPAROTOMY IN MASSIVE LOWER GA STROINTESTINAL-BLEEDING

A study of ninety-four patients admitted with massive lower gastro-int estinal bleeding (LGIB) is presented using a systematic diagnostic wor k-up including angiography, colonoscopy and various investigations, su ch as scintigraphy, small bowel series and ultrasonography. The bleedi ng source was identified preoperatively in eighty-five patients. 9 pat ients had a diagnostic laparotomy and a pathology was found in additio nal seven. No source was identified in two patients (2.1%) at explorat ion and <<blind>> subtotal colectomy was not performed in these two ca ses as proposed by others. We conclude that a thorough systematic asse ssment of patients with LGIB is important to localize the bleeding sou rce. Exploratory laparotomy is the final step in few cases (10%) and i f no intraoperative source can be identified a <<blind>> colonic resec tion should not be performed.