The Role of an Open-Access Bleeding Unit in the Management of Colonic Haemorrhage: A 2-Year Prospective Study

Abstract

Background: Major colonic haemorrhage poses difficult diagnostic and therapeutic problems and, in contrast to upper gastrointestinal bleeding, has no generally accepted plan of management. Methods: We report community-based prospective data accumulated over 2 years (1991–93) on 1602 patients referred to an open-access bleeding unit with suspected gastrointestinal haemorrhage. Results: Of 278 (17%) admissions with suspected lower GI haemorrhage, 252 were confirmed. Forty-eight per cent were defined as ‘significant’ bleeds, with a decrease in haemoglobin and cardiovascular compromise. Of 102 significant bleeds in subjects more than 60 years old, 29% rebled, and 12.6% required emergency surgery. Diverticular disease (24%) was the commonest diagnosis, with tumours, infective colitis, and inflammatory colitis each at 10%. The overall 30-day mortality for colonic bleeding was 5.1% (13 of 252), with only 1 death occurring in the group less than 60 years old. Conclusions: This study provides a unique database for the natural history of colonic bleeding and its management within the setting of a specialized bleeding unit.