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Clin Colon Rectal Surg 2003; 16(3): 205-212
DOI: 10.1055/s-2003-42904
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Lower Gastrointestinal Bleeding

Noel C. Sanchez
  • Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
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Publication Date:
10 October 2003 (online)

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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

REFERENCES

  • 1 Hughes L E. Postmorten survey of diverticular disease of the colon.  Gut . 1969;  10 336-351
    CrossrefPubMedSearch in Google Scholar
  • 2 Feldman M, Friedman L, Sleisenger M. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 7th ed. Philadelphia: WB Saunders 2002 : 226-232
    Search in Google Scholar
  • 3 Healy S J, Pfeffer R T. Exsanguinating hemorrhage from diverticulosis of the ascending colon.  N Engl J Med . 1965;  273 1480-1481
    PubMedSearch in Google Scholar
  • 4 McGuire J J, Haynes B W. Massive hemorrhage from diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in fifty cases.  Ann Surg . 1972;  175 847-853
    CrossrefPubMedSearch in Google Scholar
  • 5 Corman M L. Colon and Rectal Surgery.  4th ed. Philadelphia: Lippincott-Raven 1998: 1033-1048
    Search in Google Scholar
  • 6 Heer M, Sulse H, Haney A. Angiodysplasia of the colon: an expression of occlusive vascular disease.  Hepatogastroenterology . 1987;  34 127-131
    PubMedSearch in Google Scholar
  • 7 Helmrich G A, Stallworth J R, Brown J J. Angiodysplasia: characterization, diagnosis and advances in treatment.  South Med J . 1990;  83 1450-1453
    PubMedSearch in Google Scholar
  • 8 Robert J R, Sachar D B, Greenstein A J. Severe gastrointestinal hemorrhage in Crohn's disease.  Am Surg . 1991;  213 207-212
    CrossrefPubMedSearch in Google Scholar
  • 9 Vernava A M, Moore B A, Longo W E, Johnson F E. Lower gastrointestinal bleeding.  Dis Colon Rectum . 1997;  40 846-858
    CrossrefPubMedSearch in Google Scholar
  • 10 Gibbs D H, Opelka F G, Beck D E, Hicks T C, Timmcke A E, Gathright J B. Postpolypectomy colonic hemorrhage.  Dis Colon Rectum . 1996;  39 806-810
    CrossrefPubMedSearch in Google Scholar
  • 11 Vernava A M, Longo W E, Virgo K S, Johnson F E. A nationwide study of the incidence and etiology of lower gastrointestinal bleeding.  Surg Res Commun . 1996;  18 113-120
    PubMedSearch in Google Scholar
  • 12 Lewis B, Waye J D. Bleeding from the small intestine. In: Sugawa C, Schuman BM, Lucas CE, eds. Gastrointestinal bleeding New York: Igaku-Shoin, 1992: 178-188
    Search in Google Scholar
  • 13 Lichtenstein D R, Berman M D, Wolfe M M. Approach to the patient with upper gastrointestinal hemorrhage. In: Taylor MB, Gollan JL, Peppercorn MA, et al., eds. Gastrointestinal Emergencies 1st ed. Baltimore: Williams & Wilkins 1992: 92
    Search in Google Scholar
  • 14 Jensen D M, Machicado G A. Diagnosis and treatment of severe hematochezia: the role of urgent colonoscopy after purge.  Gastroenterology . 1998;  95 1569-1574
    PubMedSearch in Google Scholar
  • 15 Santos J M, Aprilli F, Guimaraes A S, Rosche J R. Angiodysplasia of the colon: endoscopic diagnosis and treatment.  Br J Surg . 1988;  75 256-258
    PubMedSearch in Google Scholar
  • 16 Naveau S, Aubert A, Poynard T. et al . Long-term results of treatment of vascular malformations of the gastrointestinal tract by neodymium:YAG laser photocoagulation.  Dig Dis Sci . 1990;  35 821-826
    CrossrefPubMedSearch in Google Scholar
  • 17 Savides T J, Jensen D M. Colonoscopic hemostasis for recurrent diverticular hemorrhage associated with a visible vessel: a report of three cases.  Gastrointest Endosc . 1994;  40 70-73
    PubMedSearch in Google Scholar
  • 18 Bentley D E, Richardson J D. The role of tagged red blood cell imaging in the localization of gastrointestinal bleeding.  Arch Surg . 1991;  126 821-824
    CrossrefPubMedSearch in Google Scholar
  • 19 Ng D A, Opelka F G, Beck D E. et al . Predictive value of technetium Tc 99m-labeled red blood cell scintigraphy for positive angiogram in massive lower gastrointestinal hemorrhage.  Dis Colon Rectum . 1997;  40 471-477
    CrossrefPubMedSearch in Google Scholar
  • 20 Leitman I M, Paull D E, Shires G T. Evaluation and management of massive lower gastrointestinal hemorrhage.  Ann Surg . 1989;  209 175-180
    CrossrefPubMedSearch in Google Scholar
  • 21 Browder W, Cerise E J, Litwin M S. Impact of emergency angiography in massive lower gastrointestinal bleeding.  Ann Surg . 1986;  204 530-536
    CrossrefPubMedSearch in Google Scholar