Total Colectomy versus Limited Colonic Resection for Acute Lower Gastrointestinal Bleeding Robert Farner, MD, Warren Lichliter, MD, Joseph Kuhn, MD, Tammy Fisher, RN, Dallas, Texas BACKGROUND: Acute lower gastrointestinal bleed- ing (ALGB) of the colon can be problematic to diagnose. The purpose of this study was to re- view our experience with ALGBs and to deter- mine any differences between limited colon re- section (LCR) and total/subtotal colon resection (TCR). METHODS: A retrospective study located 77 pa- tients with ALGB, who required 2 or more units of packed red blood cells prior to surgery, and who were taken to the operating room from 1987 to 1997. RESULTS: Fifty LCRs and 27 TCRs were per- formed during this 10-year period. Recurrent bleeding was significantly more common in the LCR group than in the TCR group (18% versus 4%). Morbidity and mortality were not signifi- cantly different. CONCLUSIONS: Owing to the misconception of a higher morbidity with TCR, it has been consid- ered a “last resort” instead of a more expedi- tious therapy with similar morbidities and mortal- ities. TCR should be considered more often in the management of these patients. Am J Surg. 1999;178:587–591. © 1999 by Excerpta Medica, Inc. T reatment of acute lower gastrointestinal bleeding (ALGB) has been a controversial topic for the last 30 years. The recommendations have alternated between more limited colon resection (LCR) and total/ subtotal colon resection (TCR). 1–6 The decision to per- form limited resection is often based on predicted sites of bleeding, preoperative localization studies, and concerns about the potential morbidity and mortality associated with TCR. 2,5,7,8 However, recent literature has begun to question these assumptions, demonstrating the value of TCR and the equivalent morbidity and mortality compared with LCR. 1,6,7,9 The purpose of this study was to examine the pattern of diagnosis and treatment of acute colonic bleeding. The morbidity and risk of rebleeding for LCR and TCR were compared. METHODS Between January 1987 and July 1997, a retrospective search was performed cross-referencing data from Baylor University Medical Center operating room registry and medical records department discharge summaries to iden- tify patients who had an operation performed because of ALGB. The majority of patients who presented with acute lower gastrointestinal bleeding did not require surgery and were excluded. Each of the patients in the study had ongoing bleeding and had received 2 or more units of packed red blood cells. Information on these patients was obtained through a retrospective review of all in-patient records, clinic charts, and personal follow-up data. Data collected included age, gender, etiology of bleeding, local- izing studies, amount of blood transfusions, preoperative time delay to operating room, length of surgery, morbidity, recurrent bleeding, number of postsurgical bowel move- ments, and mortality. All patients were analyzed to determine if (1) there were any significant differences in the patients who received a LCR versus TCR, and (2) there have been any significant changes between the patient data or outcome in the first 5 years compared with the second 5 years. Statistical analysis was performed using the chi-square test and Student’s t test where indicated. RESULTS Limited Colon Resection versus Total Colon Resection Seventy-seven patients underwent either a limited colon or subtotal/total colonic resection for acute lower gastro- intestinal bleeding during the 10-year period from 1987 to 1997. Fifty LCR and 27 TCR were performed. Bleeding sources included diverticuli (55%), arteriovenous malfor- mations (18%), neoplasm (17%); Table I. Localizing tests were performed in 71 patients and included tagged red blood cell (RBC) scan (n = 44), arteriogram (n = 31), and colonoscopy (n = 57). Thirty-seven percent of the tests positively localized the source of bleeding. This was accom- plished by tagged RBC scan (32%), arteriogram (42%), and colonoscopy (61%). As expected, the incidence of preoperative localization was higher in the LCR group (52%) compared with the TCR group (19%). Based on univariate analysis the TCR group time interval was 69 hours and the LCR group was 115 hours ( P 0.05). The length of surgery was significantly shorter for the LCR patients (149 minutes) compared with TCR patients (209 minutes; P 0.05); Table II. Morbidity was also compared between the two groups. From the Department of Surgery, Baylor University Medical Center, Dallas, Texas Requests for reprints should be addressed to Robert Farner, MD, Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, Texas 75246. Presented at the 51st Annual Meeting of the Southwestern Surgical Congress, Coronado, California, April 18 –21, 1999. © 1999 by Excerpta Medica, Inc. 0002-9610/99/$–see front matter 587 All rights reserved. PII S0002-9610(99)00235-4