Most patients have intermittent bleeding, or the bleeding can be controlled with non-surgical therapies. However, a minority may need to undergo surgery. In the national LGIB audit in 2018, only 117/2528 (4.6%) admitted patients underwent surgery [14].
Where possible, accurate pre-operative localisation of the bleeding site is essential to allow successful segmental resection, if not, a high rate of re-bleeding is likely. When surgery is required before any investigations are able to be undertaken, it is important to try and diagnose the bleeding point intra-operatively. When this is not possible, a subtotal colectomy is often performed.
Surgery acutely for LGIB should be considered if massive bleed, and after other therapeutic options have failed. One should take into consideration the extent and success of prior bleeding control measures, severity and source of bleeding, and the level of comorbid disease [13].
Ideally accurate pre-operative localisation of the bleeding site is essential to allow successful segmental resection, if not, a high rate of re-bleeding is likely. When surgery is required before any investigations are possible, it is important to try and diagnose the bleeding point intra-operatively. When this is not possible, a subtotal colectomy is often performed.
The image shows an anterior resection.
Learning bite
Surgery acutely for LGIB is rarely required (<5%) and should be considered after other therapeutic options have failed [14].