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Innere Medizin up2date 2013; 01(01): 23-37
DOI: 10.1055/s-0032-1326237
Verdauungsorgane
© Georg Thieme Verlag KG Stuttgart · New York

Untere gastrointestinale Blutung

Lower gastrointestinal bleeding
Jörg G. Albert
,
Christoph Sarrazin
,
Stefan Zeuzem
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Publication History

Publication Date:
09 April 2013 (online)

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Untere gastrointestinale BlutungGastroenterologie up2date 2010; 6(04): 265-278
DOI: 10.1055/s-0030-1255863

Abstract

The bleeding source in the gastrointestinal system might be assigned to the upper, mid, and lower intestinal tract. Mid intestinal bleeding comprises lesions in the small bowel and lower intestinal bleeding becomes manifest in the colon. Ileo-colonoscopy is the standard method to detect a bleeding source in the colon, and small bowel endoscopy techniques such as Capsule endoscopy and Balloon enteroscopy enable diagnosis of small bowel bleeding. Scintigrapy and small bowel radiography has rarely been used recently to investigate the small bowel for intestinal blood loss.

Frequent lesions that bleed are diverticula, angiectasias, neoplasias and chronic inflammatory bowel disease in the colon and angiectasias, ulcerations, Crohn’s disease, neoplasia and diverticula in the small bowel. Endoscopic therapy may be offered with injection techniques, electrosurgical cautery, and through-the scope clips, and new endoscopic treatment options include hemostatic powder and the over-the-scope (OTS) clipping device. For selected patients highly specialized centers offer angiography or intraoperative enteroscopy to treat intractable small bowel bleeding.

Kernaussagen

Definition, Klinik und Ursachen

  • Bei einer Blutung distal des Treitz-Bandes kann eine mittlere intestinale Blutung mit einer Blutungsquelle im Dünndarm (zwischen Treitz-Band und Bauhin-Klappe) von einer unteren intestinalen Blutung im engeren Sinn (Kolon) aus klinischer Sicht mit entsprechender epidemiologischer, diagnostischer und therapeutischer Relevanz abgegrenzt werden.

  • Die mittlere und untere gastrointestinale Blutung manifestiert sich als positiver okkulter Stuhlbluttest, als unerklärte Eisenmangelanämie, sichtbarer Teerstuhl, ein intermittierendes „Blutschmieren“ beim Stuhlgang oder als aktive Hämatochezie.

  • Häufige Blutungsquellen im Kolon sind Divertikel, Angiektasien, Neoplasien und entzündliche Darmerkrankungen unterschiedlicher Genese. Im Dünndarm werden Angiektasien, Ulzera bzw. Erosionen bei NSAR-Gebrauch oder ein Morbus Crohn, Tumoren, Metastasen und Divertikel gefunden.

Diagnostik und Therapie

  • Die Diagnostik ist eine Domäne der Koloskopie und der neuen Enteroskopieverfahren (Kapselendoskopie, Ballonenteroskopie).

  • Selten sind szintigrafische Verfahren und die Röntgenkontrastdarstellung des Dünndarms hilfreich. Für ausgewählte Patienten im spezialisierten Zentrum stehen die Angiografie und die intraoperative Enteroskopie zur Verfügung. In einigen Fällen kann die hochauflösende CT, ggf. mit Angiografie, weiterhelfen.

  • Die Therapie richtet sich nach dem Befund und ist ebenfalls eine Domäne der Endoskopie, umfasst aber auch radiologische und operative Verfahren.

 

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