Lower Gastrointestinal Bleeding

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

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