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In Reply.–The prime objective of this brief clinical note was to reaffirm the principle that, once surgical intervention is decided on, total abdominal colectomy with ileoproctostomy is the only procedure that precludes rebleeding; a secondary objective was to discourage time-consuming angiography, since identifying and resecting a portion of the colon containing the bleeding site will not prevent later rebleeding from another site.
Identification of the active bleeding site, therefore, is not entirely pertinent to our disagreement, which centers around the success in controlling diverticular bleeding with intraarterial vasopressin infusion. My own experience at Detroit General Hospital has been less than satisfactory with this technique. Reasons for failure have included inability to cannulate either the superior mesenteric artery or the inferior mesenteric artery in patients with diffuse, occlusive disease, lack of response to a standard vasopressin infusion, and rebleeding after initial success either during or following a vasopressin infusion. Comparable
LUCAS CE. Angiography in Lower Gastrointestinal Bleeding-Reply. Arch Surg. 1977;112(1):100. doi:10.1001/archsurg.1977.01370010101028