Angiography in the management of massive lower gastrointestinal tract hemorrhage.

Initial stabilization of blood volume and immediate resuscitative measures should be used for lower gastrointestinal tract bleeding. Upper gastrointestinal tract lesions should be excluded with nasogastric intubation and upper endoscopy if the history or nasogastric aspirate suggests an upper gastrointestinal tract source. Proctosigmoidoscopy should be done to exclude mucosal disease, hemorrhoidal bleeding or local carcinoma. If all of these are negative and the patient is bleeding massively, we recommend arteriography with catheterization of the superior mesenteric, inferior mesenteric and celiac arteries. These procedures should be carried out within less than four hours. If a bleeding site is demonstrated, the use of local infusion of vasopressin for permanent control should be considered only in the poor risk patient in whom the operative risk is prohibitive. Massive hemorrhage from the lower gastrointestinal tract in an elderly population is usually due to diverticular bleeding and not to angiodysplasia. The bleeding site was more common in the right than in the left colon. Angiography has been proved to be an important diagnostic procedure to localize the site of the bleeding and has been invaluable in the surgical management of these patients.