Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease

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Abstract
A series of 72 patients with bleeding either from angiodysplasia or diverticular disease of the colon has been studied in the Massachusetts General Hospital. Modern angiographic techniques have dispelled much of the mystery and reduced the mortality of colonic bleeding. In this series 85% of the bleeding originated from the right or transverse colon. Of the 72 patients, 70 survived; there were 52 operations. The 2 deaths occurred in an 81‐year‐old patient after subtotal colectomy and an 84‐year‐old patient after right colectomy, both for diverticular bleeding. After discharge from the hospital, 67 patients have been followed up for a median interval of 22 postoperative months. Late follow‐up of patients with bleeding from either angiodysplasia or diverticula showed that segmental resection was successful in stopping bleeding in 38 of 42 patients (90%); the 10 patients who had subtotal colectomy had no recurrent bleeding.The choice of operation must depend upon many factors that reflect operative risks, which must be balanced against better control of bleeding by subtotal colectomy. Because a right colectomy for angiodysplasia has been followed by recurrent bleeding in 4 of 31 cases, it is suggested that the right half of the transverse colon be included in the right colectomy since this will introduce no greater hazard and may lead to better control of bleeding. Subtotal colectomy is the operation of choice for bleeding from the colon from an unknown source, in good‐risk patients with widespread diverticulosis involving all segments of the colon, and for a combination of angiodysplasia on the right and extensive diverticular disease on the left. In poor‐risk patients, if either angiodysplasia or a single bleeding point has been demonstrated by selective arteriography, a segmentai resection of that area will be the safest procedure.

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