Pitfalls in the treatment of massive lower gastrointestinal bleeding with "blind" subtotal colectomy.

In 1969, the concept of "blind" subtotal colectomy was introduced for the treatment of patients with colonic diverticulosis and massive lower gastrointestinal (LGI) bleeding. This "policy" was soon extended to include all patients with LGI bleeding from obscure bleeding sources. In a nine-year period, ten patients presented with massive LGI bleeding, had evidence of colonic diverticula on barium-enema examination, and were explored for unrelenting bleeding. In four patients, careful exploration revealed another source for bleeding and three did well after appropriate surgery. One patient died during surgery. Six patients had blind subtotal colectomy, continued to bleed postoperatively, and three of these patients died. With the advent of selective mesenteric angiography and other preoperative diagnostic techniques, all efforts should be made to identify the exact source of bleeding and proceed with the appropriate surgery rather than subject the patient to blind subtotal colectomy.