LOWER GASTROINTESTINAL-BLEEDING

BACKGROUND: Lower gastrointestinal bleeding can be a confusing clinica l conundrum, the satisfactory evaluation and management of which requi res a disciplined and orderly approach, Diagnosis and management has e volved with the development of new technology such as selective mesent eric angiography and colonoscopy. PURPOSE: This study was undertaken t o review the available data in the literature and to determine the cur rent optimum method of evaluation and management of lower gastrointest inal hemorrhage most Likely to result in a successful outcome, METHODS : Data available on the topic of lower gastrointestinal bleeding in th e English literature were obtained via MEDLINE search and were reviewe d and analyzed. RESULTS: The colonic origin of lower gastrointestinal hemorrhage in order of decreasing incidence is diverticulosis, inflamm atory bowel disease, including ischemic and infectious colitis, coloni c neoplasia, benign anorectal disease, and arteriovenous malformations . Approximately 10 to 15 percent of all cases of rectal bleeding are a ttributable to a cause that is proximal to the ligament of Treitz. Sma ll intestinal sources such as arteriovenous malformations, diverticula , and neoplasia account for between 3 and 5 per cent of all cases. Col onoscopy successfully identified an origin in severe hematochezia in 7 4 to 82 percent of casts. Mesenteric angiography has a sensitivity of 42 to 86 percent. The best method of management depends on whether hem orrhage persists, the severity of continued hemorrhage, the cumulative transfusion requirement, and the specific origin of bleeding. CONCLUS ION: Lower gastrointestinal hemorrhage is a complex clinical problem t hat requires disciplined and sophisticated evaluation fur successful m anagement. Diverticulosis is tile most common cause. Colonoscopy is th e diagnostic procedure of choice both for its accuracy in localization and its therapeutic capability. Selective mesenteric angiography shou ld be reserved for those patients in whom colonoscopy is not practical . Precise identification of the bleeding source is crucial for a succe ssful outcome. Specific directed therapy, such as segmental colonic re section for bleeding diverticulosis, is associated with the highest su ccess rate and tile lowest morbidity. A complete review of lower gastr ointestinal bleeding is contained herein.