Aggressive colonoscopic approaches to lower intestinal bleeding.

The most obvious advantage of colonoscopy is to establish the diagnosis at any level of the colon by direct observation of the mucosal surface and identification of any active bleeding and or responsible lesions. It also enables therapeutic intervention. In a period of 18 years from 1973 to 1990, 230 emergency colonoscopic examinations were performed in 205 cases for evaluation of acute and severe bleeding from the lower intestinal tract. There were 108 men and 97 women. They appeared quite serious and needed constant medical supervision including shock treatment and blood transfusion. The ages of the patients varied from 5 months to 90 years old. There were 24 children in this series. Colonoscopy was performed within 48 hours after onset of anal bleeding. All examinations were done without fluoroscopy. It was necessary to reach the cecum in 66% of cases to determine the responsible lesions. Bleeding was identified in all except 11 cases (94.7%). Bleeding and the responsible lesions were both visualized in 147 cases (71.7%). The source of bleeding was located proximal to the ileocecal valve in 37 cases (18%). Much blood was found in the bowel which interfered observation in 14 cases. No bleeding nor lesions could be identified in 8 cases (3.9%). Most common causes of bleeding in adults were cancer, inflammatory lesions, ischemic colitis and vascular ectasia, while the most common cause of bleeding in children was juvenile polyp.(ABSTRACT TRUNCATED AT 250 WORDS)