GI Hemorrhage

LOWER GI BLEEDING
Definition: LGIB is defined as bleeding from a source distal to the ligament of Treitz
Incidence rate: 20.5 patients/ 100000/year

LGI hemorrhage
Sites
Colon – 95-97%
Small bowel – 3-5%
Only 15% of massive GI bleeding
Finding the site
Intermittent bleeding common
Up to 42% have multiple sites

LGI hemorrhage
Etiology
Diverticulosis – 40-55%
Right sided lesions > left
90% stop spontaneously
10% rebleed in 1st year and 25% at 4 years
Angiodysplasia – 3-20%
Most common cause of SB bleeding in >50 y/o
>50% are in right colon
Neoplasia
Typically bleed slowly
Inflammatory conditions
15% of UC patients, 1% of chron’s patients
Radiation, infectious, AIDS rarely
Vascular
Hemorrhoids
>50% have hemorrhoids, but only 2% of bleeding attributed to them
Others

LGI hemorrhage diagnostics
Large caliber NGT on admission
Colonoscopy
Within 12 hours in stable patients without large amounts of bleeding
Selective viseral angiography
Need >0.5 ml/min bleeding
40-75% sensitive if bleeding at time of exam
Tagged RBC scan
Can detect bleeding at 0.1 ml/min
85% sensitive if bleeding at time of exam
Not accurate in defining left vs right colon

CONCLUSION
LGIB requires pre op localization to detect the bleeding source , including rectoscopy, colonoscopy,angography and nuclear scan.
Interventional treatment by colonoscopy and selective angiographic catheterization and embolization shows good results and low bleeding rates.
If an interventional therapy is not possible, a directed limited colonic or small bowel resection should be considered.