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At least 19 recordsLinked to original sources

PubMed1994

Should Esmarch bandages be used for exsanguination in knee arthroscopy and knee replacement surgery? A prospective trial of Esmarch exsanguination versus simple elevation.

In order to compare the adequacy of exsanguination produced by Esmarch bandages with that produced by simple elevation for 2 min, a blind randomized prospective trial was undertaken in 50 patients undergoing total knee replacement surgery and 50 patients undergoing knee arthroscopy surgery. The mean blood loss during total knee replacement was significantly greater in the group exsanguinated by elevation (P < 0.01). The haematocrit of samples of the arthroscopy drainage fluid was consistently less than 1%, irrespective of the method of exsanguination used. None of the operating surgeons reported that they considered that either knee replacement surgery or arthroscopic knee surgery had been made any more difficult by the use of elevation as a means of exsanguination. In view of the established risks of using Esmarch bandages, we would suggest that the use of this method of exsanguination in these fields of orthopaedic surgery is not justified.

Arthroscopy↗

PubMed1995

Age-dependent mechanism in guinea pig bronchoconstriction induced by exsanguination.

Age-related mechanism in exsanguination-induced bronchoconstriction (EIB) was studied in guinea pigs. We used a total of 36 guinea pigs divided into three age categories (immature, adolescent, and mature). Each age category was separated into two groups: control and catalase (CAT). CAT is an antioxidant. Both saline (the control group) and CAT were instilled intratracheally 30 min before exsanguination. The animals were anesthetized, sternotomized and exsanguinated. Maximal expiratory flow (Vmax) was measured both before and 1-30 min after exsanguination. In the control group, exsanguination caused gradual decreases in both total lung capacity (TLC) and Vmax at 50% baseline TLC, and an increase in minimal lung volume, indicating EIB. EIB occurred faster in the immature than in the adolescent and mature guinea pigs, and it was significantly ameliorated by CAT. In 36 additional animals tested before exsanguination, there was no age-related change in either airway neutral endopeptidase (NEP) activity or lung tissue substance P level. Thirty minutes after exsanguination in the control groups, airway NEP activity decreased significantly in all age categories, while lung tissue substance P level increased significantly only in the immature category. CAT prevented most of these NEP and substance P changes. These data suggest that exsanguination increases production of oxygen radicals, which inactivate NEP and enhance breakdown of substance P precursor; the increased tachykinin levels induce EIB. Furthermore, our data indicate that this chain reaction is age-dependent, with a faster and more severe reaction in immature guinea pigs.

Aging↗

PubMed2000

Bier block exsanguination: a volumetric comparison and venous pressure study.

OBJECTIVES: Intravenous regional anesthesia (IVRA) is a useful ED anesthetic technique. However, venous pressure elevation during injection can cause anesthetic leakage and toxicity. This is minimized by preinjection limb exsanguination. Although standard, Esmarch exsanguination is intolerable with limb trauma. Thus, the authors' objective was to study alternative methods. METHODS: Volunteers had upper limb exsanguination performed by Esmarch bandage, arm elevation/arterial compression (AE/AC), and a pneumatic vinyl splint. Resultant volume changes, measured by volume displacement, were normalized, and expressed as percent decreases from baseline. Volume changes of all three methods were compared. The physiologic effectiveness of the AE/AC method was tested by measuring IV pressures during simulated IVRA. Attainment of maximum venous pressure (MVP) indicated leakage under the tourniquet. RESULTS: All methods reduced limb volume compared with baseline (p < 0.05). No difference occurred between AE/AC and vinyl splint exsanguination (p > 0.99), but neither method was as effective as Esmarch (p < 0.05). Gender differences were noted in absolute volumes exsanguinated, but there was no difference in percent exsanguination. The AE/AC method was the simplest procedure to perform. Peak IV pressure during simulated IVRA after AE/AC was 85 mm Hg (males), and 199 mm Hg (females) (p < 0.05). The MVP was not reached. CONCLUSIONS: While Esmarch was the most effective exsanguinating method, the two alternatives provided significant and equivalent decreases in limb volume. The AE/AC technique was physiologically effective in preventing attainment of MVP. Further studies are indicated to determine the clinical effectiveness of this technique in providing anesthesia for patients with limb trauma.

Adolescent↗

PubMed1998

Exsanguination from impact head trauma; the explanation for the "empty heart" sign.

Twenty-four autopsied cases of lethal closed head trauma occurring sufficiently rapidly for the salient pathologic features to remain unobscured by medical intervention, and selected to exclude the possibility of exsanguination by other means, were analyzed for the presence or absence of exsanguination from basal skull fracture. The purpose of this study was to test the validity of the "Empty Heart" sign in head injuries, attributed by Hirsch and Zumwalt [C.S., Hirsch, R.E., Zumwalt, The "Empty Heart" sign. The American Journal of Forensic Medicine and Pathology 7 (2) (1986) 112-114] to a hypothetical neurologic reflex causing occult intra-corporeal sequestration of blood. The study revealed that the twelve cases with more severe injuries showed clear cut exsanguination (with "empty" hearts) due to basal skull fractures, while the twelve milder injury cases showed no signs of exsanguination, including the empty heart sign. No cases of cryptogenic empty heart were found. These findings demonstrate that the "empty heart" sign is merely an indication of exsanguination due to basilar skull fracture. The mechanism of exsanguination in these cases is discussed. The author's method for the determination of depleted blood volume at autopsy is described. The routine estimation of blood volume at autopsy and the inclusion of investigative data in forensic case assessment are recommended.

Adolescent↗

PubMed2002

Hand exsanguination: prospective randomised blind study of an established versus a modified technique.

One hundred patients undergoing elective hand surgery were randomized to have their hands exsanguinated by either the Rhys-Davies exsanguinator alone or the Rhys-Davies exsanguinator supplemented by a 500 ml bag of intravenous fluid which was placed in the patient's palm as the exsanguinator was rolled up the limb. The quality of the exsanguination was assessed by the surgeon using a pre-defined subjective scoring system. There were no significant differences in the exsanguination scores of the two treatment groups.

Blood Loss, Surgical↗

PubMed2000

Electrical stunning and exsanguination decrease the extracellular volume in the broiler brain as studied with brain impendance recordings.

Electrical stunning in the process of slaughtering poultry is used to induce unconsciousness and immobilize the animal for easier processing. Unconsciousness is a function of brain damage. Brain damage has been studied with brain impedance recordings under ischemic conditions. This experiment studies brain impedance as a response to a general epileptiform insult caused by electrical stunning and ischemia caused by exsanguination. Brain impedance was recorded in 10 broiler chickens for each of three killing methods: whole body electrical stunning, which induces cardiac arrest; head only electrical stunning followed by exsanguination; and exsanguination without stunning. Brain impedance was converted into relative extracellular volume (ECV) values. Results showed that, immediately after electrical stunning, the ECV decreased 5.5% from base ECV. With exsanguination only, the ECV decreased from base ECV only after 4 min after neck cutting. The ECV decrease after 10 min did not differ between treatments. With a time of 228 s to reach one-half of the ECV decrease found at 10 min, electrical stunning resulted in a much faster change in ECV than exsanguination only (373 s). Within the head only stunning group, six animals showed a response similar to that found with whole body stunning; the other four animals responded similarly to the animals that were exsanguinated only. It was concluded that brain impedance recordings used with electrical stunning reflect brain damage. This damage was both epileptic and ischemic in nature. Whole body stunning induced immediate brain damage, suggesting that an adequate stun was delivered. The dual response found with head only stunning might indicate that this stunning method does not always produce an adequate stun.

Abattoirs↗

PubMed1994

Intratracheal antioxidants attenuate exsanguination-induced bronchoconstriction in guinea pigs.

The role of oxygen radicals in exsanguination-induced bronchoconstriction (EIB) was investigated using intratracheal instillation of antioxidants. In series 1, 49 guinea pigs (331 +/- 6 g) were employed in the functional study. These animals were divided into seven groups: control, superoxide dismutase (SOD), catalase (CAT), erythrocytes (RBCs), N-[2-(2-oxo-1-imidazolindinyl)-ethyl]-N'-phenylurea (EDU), ruthenium red (RR), and systemic capsaicin pretreatment. SOD, CAT, RBCs, and EDU are antioxidants, whereas RR is a blocker of transmembrane Ca2+ fluxes. All agents except capsaicin were administered by intratracheal instillation 30 min before exsanguination; each animal of the last group received a 5-day subcutaneous capsaicin pretreatment. All animals were anesthetized, sternotomized, and exsanguinated. Before as well as 1-30 min after exsanguination, the maximal expiratory flow maneuver was performed and the minimal volume was obtained. In the control group, exsanguination caused gradual decreases in the maximal expiratory flow at 50% baseline total lung capacity, forced expiratory volume at 0.1 s, and total lung capacity as well as a gradual increase in the minimal volume, indicating that EIB becomes more severe with time. EIB was significantly ameliorated by intratracheal instillation of SOD, CAT, RBCs, EDU, and RR, and it was almost abolished by systemic capsaicin pretreatment. In series 2, however, inactivated CAT did not significantly affect EIB. We determined tracheal neutral endopeptidase (NEP) activity in 23 animals. Thirty minutes after exsanguination, there was a significant decrease in NEP activity in the control but not the CAT group. These results indicate that EIB is modulated by oxygen radicals, which inactivate NEP.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2004

Suspended animation can allow survival without brain damage after traumatic exsanguination cardiac arrest of 60 minutes in dogs.

BACKGROUND: We have previously shown in dogs that exsanguination cardiac arrest of up to 120 minutes without trauma under profound hypothermia induced by aortic flush (suspended animation) can be survived without neurologic deficit. In the present study, the effects of major trauma (laparotomy, thoracotomy) are explored. This study is designed to better mimic the clinical scenario of an exsanguinating trauma victim, for whom suspended animation may buy time for resuscitative surgery and delayed resuscitation. METHODS: Fourteen dogs were exsanguinated over 5 minutes to cardiac arrest. Flush of saline at 2 degrees C into the femoral artery was initiated at 2 minutes of cardiac arrest and continued until a tympanic temperature of 10 degrees C was achieved. The dogs were then randomized into a control group without trauma (n = 6) or a trauma group (n = 8) that underwent a laparotomy and isolation of the spleen before hemorrhage and then, at the start of cardiac arrest, spleen transection and left thoracotomy. During cardiac arrest, splenectomy was performed. After 60 minutes of no-flow cardiac arrest, reperfusion with cardiopulmonary bypass was followed by intensive care to 72 hours. RESULTS: All 14 dogs survived to 72 hours with histologically normal brains. All control dogs were functionally neurologically intact. Four of eight trauma dogs were also functionally normal. Four had neurologic deficits, although three required prolonged mechanical ventilation because of airway edema and evidence of multiple organ failure. Blood loss from the chest and abdomen was variable and was associated with poor functional outcomes. CONCLUSION: Rapid induction of profound hypothermic suspended animation (tympanic temperature, 10 degrees C) can enable survival without brain damage after exsanguination cardiac arrest of 60 minutes even in the presence of trauma, although prolonged intensive care may be required. This technique may allow survival of exsanguinated trauma victims, who now have almost no chance of survival.

Abdominal Injuries↗

PubMed1985

The effect of exsanguination on organ weight of rats.

In three experiments, rats were anesthetized and killed by exsanguination or were killed by an overdose of anesthetic and not exsanguinated. The second group of rats in each experiment mimicked rats found dead on toxicology studies. Liver and kidney weights of rats killed by exsanguination were statistically significantly lower than those of rats not exsanguinated both in terms of gross organ weight and of percentage of body weight. The results of these experiments indicate that organ weight data of rats killed by exsanguination should be segregated from those of rats found dead. In fact, because of uncontrollable variables, organs of rats found dead should not be weighed.

Animals↗

PubMed2004

Factors affecting early exsanguination and death in blunt thoracic aortic trauma.

The traditional approach to blunt thoracic aortic injuries has been expedient diagnosis and operative repair due to the significant risk of early exsanguination and death in initial survivors. Nonoperative management has been advocated in patients with multiple injuries to reduce the operative mortality. However, specific clinical parameters and diagnostic tests that may predict the risk of early exsanguination and death have yet to be identified. A retrospective analysis of 80 patients with these injuries was undertaken to identify factors associated with early exsanguination or death. Available aortograms were also examined and graded to determine their utility in predicting these outcomes. Early exsanguination and death were found to be associated with low systolic blood pressure on admission and with short duration from injury to diagnosis. Exsanguination was also associated with the total number of lesions in thoracic injuries, and mortality with age greater than 30 years. Aortographic appearance was not found to correlate with either outcome. Patients with blunt thoracic aortic injuries should continue to be managed expediently, with immediate surgical repair if not contraindicated by associated injuries, to avoid early rupture.

Adolescent↗

PubMed1994

Oxygen radicals in exsanguination-induced bronchoconstriction of guinea pigs.

This study investigated the relationship between oxygen radicals and exsanguination-induced bronchoconstriction using antioxidant in guinea pigs. To accomplish this, two phases of studies were carried out. In phase 1, 34 guinea pigs weighing 342 +/- 11 g were divided into five groups: control (n = 7); acute dimethylthiourea (DMTU, n = 7); chronic DMTU (n = 8); superoxide dismutase (SOD, n = 6); and catalase (n = 6). Animals in the control group were not treated. DMTU, SOD, and catalase were employed for the scavenging of hydroxyl radical, superoxide anion, and hydrogen peroxide, respectively. Ten additional guinea pigs weighing 293 +/- 6 g were divided into two groups in phase 2: sham (n = 6) and chronic apocynin (n = 4). Animals in the sham group received injections of the vehicle, whereas apocynin was used to suppress the production of superoxide anion. All animals were anesthetized, sternotomized, and artificially ventilated. Before (baseline) as well as at fixed intervals 5-30 minutes following the exsanguination, the maximal expiratory flow maneuver was performed and the dynamic compliance (Cdyn) was obtained. Decreases in the maximal expiratory flow at 50% baseline vital capacity and Cdyn were used as indicators of bronchoconstriction. Exsanguination in the control and sham groups caused a gradual increase in airway constriction with time that was significantly ameliorated by chronic DMTU and chronic apocynin pretreatments but was not affected by other acute treatments. These results indicate that chronic treatment with antioxidants ameliorates exsanguination-induced, tachykinin-mediated airway constriction.

Analysis of Variance↗

PubMed1992

Successful transplantation of hearts harvested 30 minutes after death from exsanguination.

The donor pool for heart transplants is severely limited. Unfortunately, many trauma patients who might be donors die of exsanguination before their organs can be used. We tested whether hearts "dead" for one half hour after exsanguination could be used as heart transplants in 8 lambs (mean weight, 8 kg). Four lambs were exsanguinated by severing the subclavian artery while simultaneously infusing intravenous saline solution to mimic resuscitation attempts. All animals died. Thirty minutes after hypotensive arrest and death, simulating the time needed to secure donation permission, the heart was harvested, perfused with 250 mL of cold cardioplegia containing 200,000 units of streptokinase to dissolve intravascular clots, and stored in iced saline solution for a mean of 1.5 hours while 4 recipient lambs were prepared for operation. After bypass and recipient heart excision, the "dead" donor heart was transplanted orthotopically. The heart was reperfused with low flow (25 mL/min), low pressure (30 mm Hg), low hematocrit (hematocrit, 0.08 to 0.12) blood supplemented with prostaglandin E1 and nifedipine for 15 minutes, followed by full flow rewarming for 45 minutes. All hearts resumed normal contractions. All animals were weaned from bypass without inotropes. Pressures a half hour after bypass were (in mm Hg): aorta, 80 +/- 10; pulmonary artery, 20 +/- 5; right atrium, 9 +/- 5; and left atrium, 9 +/- 2. We conclude that hearts "dead" for one half hour after exsanguination are capable of being reanimated and used successfully as donor organs. With further development, this method could potentially greatly expand the donor heart pool.

Animals↗

PubMed1997

Water-soluble fullerene derivatives attenuate exsanguination-induced bronchoconstriction of guinea-pigs.

1. This study investigated the effects of increased antioxidants (administration of water-soluble fullerenol-1 and pre-exposure to chronic hypoxia) as well as an iron-chelating agent (deferoxamine) on exsanguination-induced noncholinergic airway constriction in guinea-pigs. 2. Fullerenol-1 usually did not cause significant alteration in respiratory function (lung volumes, dynamic respiratory compliance, maximal expiratory flow at 50% total lung capacity (Vmax50), and forced expiratory flow at 0.1 s (FEV 0.1) at low (200 micrograms kg-1) or at high doses (2 mg kg-1), except that it produced a slight bronchial constricting action (decreases in both Vmax 50 and FEV 0.1) at high doses (2 mg kg-1) via intratracheal instillation. 3. Beginning 15 min after exsanguination, there was a marked temporal decrease in FEV 0.1, indicating a gradual increase in airway constriction with time. 4. Administration of either fullerenol-1 or deferoxamine, or pre-exposure to chronic hypoxia significantly ameliorated the exsanguination-induced bronchoconstriction. The results provide evidence that oxygen radicals play an important role in exsanguination-induced airway constriction. 5. The significant effects of the increased antioxidants and deferoxamine,however, cannot be explained by the alteration in either tracheal neutral endopeptidase activity or lung tissue substance P level.

Animals↗

PubMed2000

Radioactive waste minimization implications of clinically-indicated exsanguination procedures.

Exsanguination is a method of animal euthanasia approved for use in specific circumstances. Animals undergoing exsanguination are fully anesthetized, and the blood is removed resulting in hypovolemia. In situations where radioactive materials are used as part of a research protocol that remain predominantly suspended in the blood, the exsanguination procedure can result in a significant lowering of residual radioactivity content. This reduction can greatly affect the types of waste management and minimization options that can be subsequently applied. In this study, data were collected from 20 rabbits injected with approximately 29.6 MBq (0.8 mCi) of tritiated thymidine as part of a percutaneous transluminal carotid artery angioplasty study. Residual concentrations of radioactivity were consistently reduced by an average of 88%. The reduction was very significant in this instance, since the residual activities were below the established exemption limit of 1.85 kBq g(-1) (0.05 microCi g(-1)) for disposal of these wastes as non-radioactive. Although the exsanguination procedure can result in significant waste minimization opportunities in certain circumstances, this should not be the rationale for its use. Rather, the method of euthanasia should be based exclusively on sound animal care and use principles, and waste management strategies should then be made following that decision. Health Phys. 79(3):291-293; 2000 Key words: waste, low-level; waste management; radiation protection; blood

Animals↗

PubMed1999

Hypothermic aortic arch flush for preservation during exsanguination cardiac arrest of 15 minutes in dogs.

BACKGROUND: Trauma victims rarely survive cardiac arrest from exsanguination. Survivors may suffer neurologic damage. Our hypothesis was that a hypothermic aortic arch flush of 500 mL of isotonic saline solution at 4 degrees C, compared with 24 degrees C (room temperature), administered at the start of prolonged exsanguination cardiac arrest (CA) would improve functional neurologic outcome in dogs. METHODS: Seventeen male hunting dogs were prepared under light N2O-halothane anesthesia. The animals were randomized into two groups: group I (n = 9) received 4 degrees C isotonic saline flush and group II (n = 6) received 24 degrees C flush. Two additional dogs received no flush. While spontaneously breathing, the dogs underwent normothermic (tympanic membrane temperature [Ttm] = 37.5 degrees C) exsanguination over 5 minutes to cardiac arrest, assured by electric induction of ventricular fibrillation. After 2 minutes of arrest, the flush was administered over 1 minute into the aortic arch by means of a 13 French balloon-tipped catheter inserted by means of the femoral artery. After 15 minutes of CA, resuscitation was with closed-chest cardiopulmonary bypass, return of shed blood, and defibrillation. For the first 12 hours after CA, core temperature was maintained at 34 degrees C. Mechanical ventilation was continued to 20 hours and intensive care to 72 hours, when final evaluation and perfusion-fixation killing for brain histologic damage scoring were performed. RESULTS: Three dogs in group I were excluded because of extracerebral complications. All 14 dogs that followed protocol survived. During CA, the Ttm decreased to 33.6 +/- 1.2 degrees C in group I and 35.9 +/- 0.4 degrees C in group II (p = 0.002). At 72 hours, in group I, all dogs achieved an overall performance category (OPC) of 1 (normal). In group II, 1 dog was OPC 2 (moderate disability), 3 dogs were OPC 3 (severe disability), and 2 dogs were OPC 4 (coma). Both dogs without flush were OPC 4. Neurologic deficit scores (NDS 0% = normal, 100% = brain death) were 1 +/- 1% in group I and 41 +/- 12% in group II (p < 0.05). The two dogs without flush achieved an NDS of 47% and 59%. Total brain histologic damage scores were 35 +/- 28 in group I and 82 +/- 17 in group II (p < 0.01); and 124 and 200 in the nonflushed dogs. CONCLUSION: At the start of 15 minutes of exsanguination cardiac arrest in dogs, hypothermic aortic arch flush allows resuscitation to survival with normal neurologic function and histologically almost clean brains.

Animals↗

PubMed1998

A Simple Exsanguination Method That Minimizes Acute Pre-anesthesia Stress in the Mouse: Evidence Based on Serum Corticosterone Concentrations.

Enormous variability exists among published values for serum corticosterone concentration of mice. Exsanguination of mice is widely used and has been little-tested, but is a likely variable to affect corticosterone concentrations. Exsanguination may impose unrecognized and unnecessary distress on mice used in research. Male and female C57BL/6J mice that were 25 to 30 days old were housed separately, and blood samples were obtained between 9 and 10 a. m. Methoxyflurane and CO2 were each used to induce anesthesia. Mice were anesthetized in the housing room (to minimize environment- and transport-related stress) or in an adjacent room after a transport procedure that required 30 seconds or less. Mice were accustomed to transportation in their cages while in the housing room, and CO2 anesthesia involved placing the entire cage in a chamber flushed with CO2. Serum corticosterone concentrations, determined by radioimmunoassay, were 32 6 17, 113 6 37, 103 6 32, and 97 6 34 ng/ml (mean 6 SEM, n = 10 mice/group) for mice in anesthesia groups housing room/CO2, housing room/methoxyflurane, transport stress/CO2, and transport stress/methoxyflurane, respectively. Values for the housing room/CO2 group differed significantly (P < 0.05, two-way ANOVA; least-squares means) from values for the other groups and appeared to define the serum corticosterone concentration of quiescent laboratory mice. A subsequent study yielded a serum corticosterone concentration of 31 6 5 ng/ml (mean 6 SEM) in 16 adolescent C57BL/6J mice exsanguinated in the same manner. Finally, exsanguination of 4 groups of 5 young adult C57BL/6J mice, each group in timed sequence, by means of the housing room/CO2 procedure indicated that distress communicated by the mice did not disturb adjacent mice in the room (i. e., mice used subsequently in each sequence), as determined on the basis of the serum corticosterone concentration. Use of CO2 to induce anesthesia coupled with a familiar routine and environment constitutes an important procedural refinement in terms of reduction in acute distress preceding anesthesia in the mouse.

Journal Article↗

PubMedDate not supplied

Exsanguinating upper extremity vascular injury: is an initial approach by clavicular resection adequate?

Clavicular resection has been recommended by some as an acceptable approach to the repair of subclavian and axillary vascular injuries. We believe this may not be the best approach in patients with severe trauma and exsanguinating injuries. During the last 5 years, we have treated 11 patients with trauma to the subclavian or axillary vessels, four of whom presented in shock from exsanguinating injuries. After initial fluid resuscitation, we operated on each patient by resecting the medial portion of the clavicle. Three of the four patients required further surgery or extension of the incision to control bleeding. In our experience, clavicular resection as a primary approach to exsanguinating injuries did not provide either adequate tamponade of bleeding or the exposure needed to repair injured vessels safely. Clavicular resection may be acceptable for hemodynamically-stable patients with minimal soft tissue damage and simple, right-sided vessel lacerations, but we cannot recommend it as an initial approach in patients with severe, exsanguinating injuries.

Accidents, Traffic↗

PubMed1995

Life-threatening hemorrhage and exsanguination from Crohn's disease. Report of four cases.

PURPOSE AND METHODS: From 1979 through 1991, four patients of 631 admissions (0.6 percent) for Crohn's disease in Erie, Pennsylvania, presented with life-threatening gastrointestinal hemorrhage. These and 34 similar cases from the medical literature were reviewed to provide a composite of those at risk and elucidate appropriate diagnostic and therapeutic maneuvers. RESULTS: The study revealed a preponderance of young men (2:1 ratio) with an average age of 35 (range, 14-89) years, the majority of whom had known Crohn's disease (60 percent) for an average of 4.6 (range, 0-18) years. The site of bleeding resembled the general distribution for Crohn's disease, with small bowel disease predominating (66 percent involved the ileum). The five cases of exsanguination (13 percent of the total) were all men with known Crohn's disease (average, 5.8 years) involving the ileum alone or in part. Mesenteric arteriography was positive in 17 patients, providing precise preoperative localization resulting in no mortality in this group. Excluding those who presented with exsanguination, surgery was necessary to cease hemorrhage in 91 percent (30/33) of patients. Ileocolectomy was the most frequently performed procedure (53 percent). In follow-up, only one patient required further surgical resection for recurrent bleeding (3.5 percent), and two other patients (7 percent) required further therapy for nonhemorrhagic recurrence. CONCLUSION: Crohn's disease may be responsible for life-threatening gastrointestinal hemorrhage and even exsanguination. Many of the characteristics of these patients resemble the general Crohn's disease population. Surgical resection provides excellent palliation. A long-term benign course can be expected in this subgroup of Crohn's disease patients.

Adolescent↗