Zusammenfassung
Blutungen aus dem Gastrointestinaltrakt werden in obere, mittlere und untere gastrointestinale Blutung unterschieden. Die Diagnostik kann eine Herausforderung sein und ist eine Domäne der Koloskopie, der Kapselendoskopie oder der flexiblen Enteroskopieverfahren. Als endoskopische Therapieoptionen stehen die Injektionstherapie, Metallclips, eine thermische Behandlung sowie die Gummibandligatur zur Verfügung, eine chirurgische Resektion ist nur selten erforderlich.
Abstract
Acute lower gastrointestinal bleeding (GI) is the reason in about 20 to 40% of patients who present with clinical signs of intestinal bleeding. The frequency of upper GI seems to decrease and the incidence of upper and lower GI bleeding are approaching. The classification is based on the anatomical landmarks Treitzʼ ligament and Bauhinʼs valve and delimited from a clinical point of view with corresponding epidemiological, diagnostic and therapeutic relevance. Mid and lower GI bleeding manifests overt as hematochezia, visible tarry stools and intermittent blood smearing during defecation, or occult as a positive stool blood test and unexplained iron deficiency anemia. Common sources of bleeding in the colon are diverticula, angiectasias, neoplasias and inflammatory bowel diseases of various origins. In the small intestine, angiectasias, ulcers or erosions associated with the use of NSAIDs or, more rarely, Crohnʼs disease, tumors, metastases and diverticula are found to be the cause of bleeding. Diagnostics is a domain of colonoscopy and capsule endoscopy or flexible enteroscopy methods (balloon enteroscopy or spiral enteroscopy). If the endoscopy does not find the source of the bleeding or does not allow it to be treated, high-resolution angio-CT, optionally with subsequent interventional angiography, can help. Very rarely, scintigrafic procedures are useful. Only rarely, a surgical resection is necessary and can be combined with an intraoperative enteroscopy within the same session.
Schlüsselwörter
gastrointestinale Blutung - Endoskopie - Koloskopie
Key words
intestinal bleeding - endoscopy - colonoscopy
