ABSTRACT
Lower gastrointestinal bleeding encompasses a wide spectrum of gastrointestinal disorders
that can challenge even the most experienced clinician. Treatment of these patients
involves initial resuscitation followed by identification of the bleeding site. Therapeutic
treatment modalities can then be instituted if the bleeding persists. Although the
best initial diagnostic approach is controversial, we utilize an algorithm to guide
our evaluation efficiently. For the patient who is actively bleeding, nuclear scintigraphy
is a safe, noninvasive study that will identify the site of persistent hemorrhage
in the majority of patients. In addition, nuclear scintigraphy is useful to help select
patients who may benefit from the diagnostic and therapeutic potential of angiography.
When the bleeding has stopped or significantly slowed, colonoscopy is the diagnostic
procedure of choice because of its high diagnostic accuracy and therapeutic capability.
Fortunately, in the majority of cases, lower gastrointestinal bleeding stops spontaneously.
However, if the bleeding continues and the site remains unlocalized, a subtotal colectomy
should be considered. For a bleeding site that has been localized, a segmental resection
is the treatment of choice.
KEYWORDS
Lower gastrointestinal hemorrhage - nuclear scintigraphy - colonoscopy - angiography
