pituitrin and Diverticulum--Colon

Topics: Aged; Angiography; Diverticulum, Colon; Embolization, Therapeutic; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Injections, Intra-Arterial; Injections, Intravenous; Male; Middle Aged; Peptic Ulcer Hemorrhage; Vasopressins

Topics: Anesthesia; Diverticulum, Colon; Humans; Hypotension; Intestinal Perforation; Male; Middle Aged; Norepinephrine; Postoperative Complications; Receptors, Adrenergic; Sepsis; Sympathomimetics; Vasoconstrictor Agents; Vasopressins

Fifty patients with massive lower gastrointestinal bleeding were initially managed with emergency angiography. The average age was 67.2; mean hematocrit, 23.7; and average transfusion, 7.6 units. Thirty-six patients (72%) had bleeding site located; bleeding sites were distributed throughout the colon. Etiologies of bleeding included diverticular disease (19 patients) and arteriovenous malformations (15 patients). Twenty of 22 (91%) patients receiving selective intra-arterial vasopressin stopped bleeding; however, 50% rebled on cessation of vasopressin. Thirty-five of 50 (70%) patients underwent surgery, with 57% operated on electively after vasopressin therapy. Seventeen patients had segmental colectomy, with no rebleeding. Nine of the 17 patients had diverticular disease in the remaining colon. Operative morbidity in these 35 patients was significantly improved when compared to previously reported patients undergoing emergency subtotal colectomy without angiography (8.6% vs. 37%) (p less than 0.02). Emergency angiography successfully locates the bleeding site, allowing for segmental colectomy. Vasopressin infusion transiently halts bleeding, permitting elective surgery in many instances.

Topics: Adult; Aged; Angiography; Arteriovenous Malformations; Barium Sulfate; Colectomy; Colon; Diverticulum; Diverticulum, Colon; Emergencies; Female; Gastrointestinal Hemorrhage; Humans; Male; Mesenteric Arteries; Middle Aged; Vasopressins

The management of lower gastrointestinal bleeding has evolved from a number of technological advances allowing precise diagnosis and localization of the bleeding site. This study of 40 angiographically demonstrated lower gastrointestinal bleeding lesions reinforces much of the data indicating the diagnostic and therapeutic trends. Twenty-four patients had bleeding diverticula with angiographic demonstration in 11 patients. Seven cases of vascular ectasia were identified, and nine patients had a variety of significant bleeding sites other than the two main sites that were listed. Pitressin was useful for control of bleeding in six of seven diverticular patients but was less useful in the vascular ectasia group in which only one patient was actively bleeding. Total abdominal colectomy and segmental resection were successful in control of hematochezia in 24 of 25 operative cases. Sixteen patients did not require surgical treatment.

Topics: Aged; Angiography; Arginine Vasopressin; Colectomy; Diverticulum, Colon; Diverticulum, Stomach; Female; Gastrointestinal Hemorrhage; Humans; Hypertension; Male; Middle Aged; Vasopressins

Topics: Acute Disease; Adult; Aged; Diverticulum, Colon; Duodenal Ulcer; Gastritis; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Mallory-Weiss Syndrome; Middle Aged; Peptic Ulcer Hemorrhage; Radiography; Stomach; Stomach Ulcer; Varicose Veins; Vasopressins

Topics: Adult; Aged; Arteriovenous Malformations; Colonic Diseases; Diverticulum, Colon; Female; Gastrointestinal Hemorrhage; Humans; Intestine, Small; Intestines; Male; Middle Aged; Rectal Diseases; Vasopressins

Large-bowel bleeding usually arises from either angiodysplasia or colonic diverticula. Diverticular bleeding is more common in the right or the transverse colon, even though diverticula are more common on the left. Arteriography in these patients may identify the bleeding site, and in some cases vasopressin infusion controls the bleeding. Embolization of the large bowel is not recommended because of the danger of necrosis.

Topics: Aged; Angiography; Colon; Diverticulum, Colon; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Male; Mesenteric Arteries; Rectum; Vasopressins

Twenty-four patients with massive rectal hemorrhage and known or subsequently proved colonic diverticular disease had the bleeding site localized by mesenteric angiography and received intra-arterial infusion of vasopressin to arrest the bleeding. In twenty-two patients the bleeding was controlled with the vasopressin infusion whereas in the remaining two, hemorrhage did not stop and surgery was performed. Of the twenty-two patients in whom bleeding was arrested by vasopressin infusion, twelve received no further surgical therapy, five had elective prophylactic surgical resection after a period of hemostasis, and the remaining five underwent segmental resection for bleeding that recurred after cessation of the infusion. Of the twelve patients who were not operated on, three had rebleeding two, four, and twelve months after vasopressin infusion and two of these three patients required surgery. The remaining nine have had no recurrent bleeding for periods ranging from seven to thirty-four months. Of ten patients who had segmental resection after precise localization of the bleeding site and initial control with vasopressin, no one has had recurrent hemorrhage for periods ranging from two to eighteen months.

Topics: Aged; Diverticulum, Colon; Evaluation Studies as Topic; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Infusions, Parenteral; Male; Mesenteric Arteries; Radiography; Recurrence; Vasopressins

Topics: Adult; Aged; Angiography; Colonic Diseases; Diverticulum, Colon; Gastrointestinal Hemorrhage; Humans; Male; Mesenteric Arteries; Mesenteric Veins; Middle Aged; Perfusion; Vasopressins

Angiography has added a new dimension to the management of hemorrhage from the large bowel. In patients with diverticular hemorrhage, mesenteric angiography not only localizes the bleeding site but, in addition, the bleeding can be acutely controlled with intraarterial infusion of vasopressin, making an emergency colectomy unnecessary. Similarly in patients bleeding from inflammatory bowel disease or in patients with post-operative hemorrhage, angiography provides information about the nature of the lesion and selective arterial infusions of vasopressin can control the bleeding. At times intestinal varices have angiographically been demonstrated as a potential source of rectal hemorrhage while in patients with unexplained lower gastrointestinal bleeding and repeatedly negative barium and endoscopic examinations, angiography has been valuable for the diagnosis of angiodysplasia of the colon.

Topics: Acute Disease; Aged; Angiography; Blood Vessels; Colitis, Ulcerative; Colon; Colonic Neoplasms; Diverticulum, Colon; Endoscopy; Gastrointestinal Hemorrhage; Humans; Intestinal Polyps; Intestine, Large; Male; Mesenteric Arteries; Middle Aged; Varicose Veins; Vasopressins

Topics: Aged; Angiography; Colectomy; Diverticulum, Colon; Female; Gastrointestinal Hemorrhage; Humans; Mesenteric Arteries; Vasopressins

Topics: Adult; Aged; Arteries; Capillaries; Celiac Artery; Colonic Diseases; Diverticulum, Colon; Duodenal Ulcer; Epinephrine; Gastritis; Gastrointestinal Hemorrhage; Hernia, Diaphragmatic; Humans; Infusions, Parenteral; Male; Mallory-Weiss Syndrome; Mesenteric Arteries; Middle Aged; Peptic Ulcer Hemorrhage; Radiography; Stomach Ulcer; Vasopressins

Topics: Acute Disease; Adult; Aged; Alcoholism; Animals; Colitis; Colitis, Ulcerative; Diverticulum, Colon; Dogs; Epinephrine; Female; Gastrointestinal Hemorrhage; Humans; Ileitis; Injections, Intra-Arterial; Male; Mesenteric Arteries; Middle Aged; Peptic Ulcer Hemorrhage; Propranolol; Regional Blood Flow; Stomach Ulcer; Vasoconstrictor Agents; Vasopressins