Our Summary

This study looked at a way to treat patients who have severe bleeding in the lower part of their digestive tract due to a condition called diverticulosis. Usually, these patients have to undergo a total colectomy, which is a surgery to remove the entire colon, because doctors can’t locate the exact spot of the bleeding. However, this study found that in most cases, the bleeding doesn’t spread far.

The researchers tested a new method, called the positive endoluminal erythrocyte presence (PEEP) test, which involves looking for fresh blood in a part of the colon called the caecum. They used this test to guide a less invasive surgery, called a segmental colectomy, which removes only a part of the colon, on 14 patients.

The results were promising: 93% of the patients stopped bleeding after the surgery. There were no deaths, and only 14% of patients had complications after the surgery. Only one patient had to have a total colectomy because the bleeding didn’t stop.

Therefore, the researchers suggest that surgeons consider using the PEEP test to guide a segmental colectomy when they can’t locate the bleeding. However, they recommend a total colectomy if the PEEP test results are unclear, or if the patient continues to bleed significantly after the surgery.

FAQs

  1. What is the PEEP test used for in colectomy procedures?
  2. What were the results of using the PEEP test to guide segmental colectomies in patients with lower GI haemorrhage?
  3. When is a blind total colectomy recommended based on the PEEP test results?

Doctor’s Tip

One helpful tip a doctor might tell a patient about colectomy is to follow post-operative care instructions carefully, including taking prescribed medications, eating a healthy diet, and attending follow-up appointments. It is also important to monitor for any signs of infection or complications and to seek medical attention if any concerns arise. Additionally, maintaining good communication with your healthcare team and asking any questions or expressing any concerns you may have can help ensure a successful recovery.

Suitable For

Patients who are typically recommended for colectomy include those with massive lower gastrointestinal (GI) hemorrhage from diverticulosis when preoperative localization is unavailable. In these cases, total colectomy may be necessary. However, segmental colectomy guided by a positive endoluminal erythrocyte presence (PEEP) test (presence of fresh blood in the caecum) may be considered as an alternative approach in patients requiring emergency operations for massive lower GI hemorrhage. Segmental resection guided by the PEEP test has been shown to successfully control bleeding in a high percentage of cases, with low postoperative morbidity and no mortality. Blind total colectomy may be considered if the PEEP test is equivocal, and early completion colectomy may be necessary in cases of significant re-bleeding.

Timeline

Before colectomy:

  1. Patient presents with massive lower GI hemorrhage from diverticulosis.
  2. Preoperative localisation is unavailable.
  3. Patient may undergo diagnostic tests such as colonoscopy, CT scan, or angiography to identify the source of bleeding.
  4. Decision is made to proceed with colectomy due to inability to localise the bleeding site.

After colectomy:

  1. Colectomy is performed, either total or segmental, guided by the PEEP test (presence of fresh blood in the caecum).
  2. 13 out of 14 patients who had segmental colectomy guided by the PEEP test had successful control of bleeding.
  3. Postoperative morbidity is 14% with no mortality reported.
  4. One patient required a completion colectomy on the third postoperative day due to persistent bleeding.
  5. The PEEP test is proposed as a valuable tool to guide segmental resections in cases of massive lower GI hemorrhage without localisation.
  6. Blind total colectomy is recommended if the PEEP test is equivocal, and early completion colectomy is advised in cases of significant re-bleeding.

What to Ask Your Doctor

  1. What is the reason for recommending a colectomy in my case?
  2. Are there any alternative treatments or procedures that could be considered before proceeding with a colectomy?
  3. What are the potential risks and complications associated with a colectomy?
  4. How long is the recovery period after a colectomy?
  5. Will I need to make any lifestyle changes or modifications to my diet after the surgery?
  6. How will a colectomy affect my bowel function and quality of life in the long term?
  7. Are there any specific factors or conditions that could impact the success of the surgery in my case?
  8. What is the expected outcome or prognosis after a colectomy?
  9. Will I need any additional follow-up appointments or monitoring after the surgery?
  10. Are there any support resources or services available for patients undergoing a colectomy?

Reference

Authors: Naraynsingh V, Cawich SO, Hassranah D, Daniel F, Maharaj R, Harnarayan P. Journal: Trop Doct. 2017 Oct;47(4):355-359. doi: 10.1177/0049475517724690. Epub 2017 Aug 1. PMID: 28764591