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Invited Critique
August 2010

All Bleeding Stops EventuallyComment on “Laparoscopic Ilestomy in Severe, Obscure Gastrointestinal Hemorrhage”

Author Affiliations

Author Affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison.

Arch Surg. 2010;145(8):748. doi:10.1001/archsurg.2010.123

Eat when you can, sleep when you can, and never mess with the pancreas.” “Never let the sun set on a bowel obstruction.” “All bleeding stops eventually.” These are just a few of the clinical platitudes commonly passed on from one generation of surgical trainees to the next. Each comment is slightly sarcastic and, for the most part, based on real frustrations surgeons encounter. Significant and occult gastrointestinal bleeding is on the list of most every surgeon's least favorite patient consultations. Do we watch the patient continue to bleed, hoping the bleeding will stop or the source may become more obvious? Do we operate and run the risk that we may encounter multiple potential sources or none at all? Do we deduce the most likely source in an operation and perform a resection with the intent of addressing the bleeding problem, only to have the patient continue to bleed or to bleed again? These are a few questions that keep surgeons awake at night after getting that call.

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