Surgery in Acute Lower Gastrointestinal Bleeding

In a cohort study of 10,342 acute lower gastrointestinal bleeding (ALGIB) cases, surgery was performed in 1.3%. Colonoscopy (87.7%) and endoscopic hemostasis (26.7%) were common. Surgery indications included diverticular bleeding (24%) and colorectal cancer (22%). Sixty-four percent were for severe refractory bleeding. Postoperative rebleeding rates were 22% (presumptive/obscure source) and 12% (definitive identification). Thirty-day mortality was 1.5% with surgery and 0.8% without. Transfusion need, in-hospital rebleeding, small bowel bleeding, colorectal cancer, and hemorrhoids were surgery-related risk factors. Emphasizing endoscopic hemostasis may reduce unnecessary ALGIB surgeries.