When a patient has a clinical situation of bleeding from the colon, it is important to determine the source of the bleeding and the rate of blood loss. Simultaneously, the patient's condition must be evaluated continuously and may require admission to an intensive care unit (ICU); placement of large IV's in the arms, groin, or neck; administration of IV fluids; and even administration of blood products.
Once the patient is found to have a bleeding source (usually by angiography or colonoscopy), treatment can begin. As many as 90% of vascular ectasias stop bleeding spontaneously, without any specific intervention.
When intervention is needed, however, the colonoscope can cauterize (burn) the site of hemorrhage. This procedure can be done electrically, with heat or with a laser. Complications of this procedure include perforation of the colon, as well as possible treatment failure.
Actively bleeding vascular ectasia can also be treated by angiography by clotting the blood supply to the bleeding area of the colon. The use of chemicals that cause the blood vessels to constrict can also be administered, whether by angiography or colonoscope.
In some instances, surgery is the only option. A right hemicolectomy, or removal of the entire right side of the colon, may be required. This remains the treatment of choice for a patient whose ectasia continues to bleed at a dangerously quick rate, despite several therapeutic interventions by angiography and colonoscopy.
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