Bender et al evaluated patients who underwent colectomy for massive lower gastrointestinal bleeding. They identified factors that can identify a patient who may require more aggressive management. The authors are from Wayne State University in Detroit, Michigan.
Patient selection: Adult with massive lower gastroinetestinal bleeding requiring total colectomy
Parameters:
(1) age of the patient in years
(2) number of blood products transfused
If < 10 units of blood were transfused, the morbidity and mortality was low.
If >= 10 units were transfused the morbidity and mortality increased with age:
Age in Years
Mortality
50 - 69 years
22%
70 - 79 years
43%
80 - 89 years
100%
Patients who had >= 10 units of blood transfused had a high rate (25%) of anastomotic leaks. The authors recommended ileostomy for these patients.
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