Lower GI Hemorrhage
- LGIB comprises 30–40% of all GI bleeds and is the most common cause of hospitalization due to GI disease in the United States.
- The incidence of LGIB is increasing, especially in octogenarians.
- The most common cause of LGIB is diverticular disease followed by anorectal disease and ischemia.
- A focused H&P (history and physical examination) is most effective in determining the cause of bleeding, and initial resuscitation should be focused on restoring hemodynamic stability with volume and/or blood.
- Characteristics of timing, type of bleeding, volume, and anoscopy can help to rapidly identify appropriate treatment based on potential source and rate of bleeding.
- Appropriate risk stratification can help better predict morbidity and mortality as well as guide appropriate management schemes.
- Upper and lower endoscopy is the preferred initial mode of diagnosis for LGIB. This method best allows for not only potential source identification but offers the potential for therapeutic intervention.
- Radiologic studies can be effective early diagnostic modalities in identifying the source of bleeding. CT angiography has a high sensitivity and specificity and is widely available. Catheter-based angiography can both diagnose and potentially treat bleeding sources if bleeding is brisk enough via transcatheter embolization.
- Nuclear scintigraphy, either via 99mTc-sulfur colloid or 99mTc-labeled RBC, can be used to identify bleeding sources that are intermittent or too slow to be identified by CTA or direct angiography.
- Recurrent LGIB is a common problem, and repeated evaluation has additive success rates.
- All attempts at localization should be made in the stable patient prior to consideration of surgical intervention.
- Obscure GI bleeding is defined as bleeding from a source that has not been identified after appropriate endoscopic and radiologic evaluation.
- Most sources of obscure GI bleeding tend to come from the small bowel, and capsule endoscopy is indicated to try and diagnose.
- Double balloon enteroscopy is an advanced modality which may be employed to diagnose and treat bleeding sources in the proximal small bowel.
- Surgery is indicated in patients in whom conservative measures have failed and/or bleeding is causing hemodynamic instability or who have reached significant transfusion thresholds.
- For refractory LGIB that are colonic in origin, but remain unlocalized, a total colectomy with ileostomy should be performed.
- For bleeding from an ongoing or refractory source that is localized, a segmental colectomy may be performed.
- Combining clinical pathways incorporating risk stratification may be helpful in providing a more systematic approach to management of LGIB and improving patient outcomes.
There's more to see -- the rest of this topic is available only to subscribers.
Last updated: January 26, 2022
Jafari, Mehraneh D, and . "Lower GI Hemorrhage." ASCRS Textbook of Colon and Rectal Surgery, 2022. ASCRS U, www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285035/all/Lower_GI_Hemorrhage.
Jafari MD, . Lower GI Hemorrhage. ASCRS Textbook of Colon and Rectal Surgery. 2022. https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285035/all/Lower_GI_Hemorrhage. Accessed December 9, 2023.
Jafari, M. D., & , . (2022). Lower GI Hemorrhage. In ASCRS Textbook of Colon and Rectal Surgery https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285035/all/Lower_GI_Hemorrhage
Jafari MD, . Lower GI Hemorrhage [Internet]. In: ASCRS Textbook of Colon and Rectal Surgery. ; 2022. [cited 2023 December 09]. Available from: https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285035/all/Lower_GI_Hemorrhage.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Lower GI Hemorrhage ID - 2285035 A1 - Jafari,Mehraneh, AU - ,, Y1 - 2022/01/26/ BT - ASCRS Textbook of Colon and Rectal Surgery UR - https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285035/all/Lower_GI_Hemorrhage DB - ASCRS U DP - Unbound Medicine ER -