Comparison of the value of emergency mesenteric angiography and intraoperative colonoscopy with antegrade colonic irrigation in massive rectal haemorrhage.

The investigation of massive rectal haemorrhage has routinely included emergency mesenteric angiography to identify the site of bleeding in preparation for surgery. Nine cases over 18 months were identified from the angiography register and reviewed retrospectively. Angiography demonstrated the bleeding point in only one case, rendering colonoscopy unnecessary. However, that patient became shocked, requiring six units of blood during angiography. A second patient suffered cardiac arrest during angiography. The mean time taken was 1 1/2 h constituting a considerable delay before proceeding to surgery. On-table colonoscopy with antegrade lavage showed the bleeding site in seven out of nine cases and the mean time for operation was 3 h. One patient stopped bleeding spontaneously and there was one postoperative death from an unrelated cause. We conclude that there is no place for emergency mesenteric angiography in massive acute large bowel haemorrhage and that early surgery with antegrade colonic lavage and on-table colonoscopy is the treatment of choice.