What are key points in the diagnosis and management of lower GI bleeding?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Answer

Note the following:

  • The physical examination should be thorough and include the skin, oropharynx, nasopharynx, abdomen, perineum, and anorectum. Therefore, nasogastric tube insertion, digital rectal examination, and anoscopy/proctoscopy should be part of the initial physical examination in all patients.
  • In most patients with LGIB, colonoscopy is the initial diagnostic method of choice. Colonoscopy is successfully used to identify the site of severe LGIB in approximately 80%-90% of patients.
  • Nuclear scintigraphy is a sensitive diagnostic tool and can detect hemorrhage at rates as low as 0.1 mL/min (0.1-0.5 mL/min), as opposed to angiography, which detects bleeding at rates of 1-1.5 mL/min.
  • Because of the high false-localization rate (10%-60%) for the bleeding site, performing segmental resections based solely on scintigraphy results is not recommended unless an immediate blush can be identified at the start of the study.
  • Emergency angiography as an initial study is indicated in a highly select group of patients with massive ongoing LGIB.
  • Segmental bowel resection following precise localization of the bleeding point is the preferred treatment because of its low postoperative morbidity and mortality when compared with subtotal colectomy.
  • Subtotal (total abdominal) colectomy with temporary end ileostomy is the procedure of choice in patients who are actively bleeding from an unknown source.
  • Blind segmental resection should not be performed because of a prohibitively high rebleeding rate, morbidity, and mortality rate.

For patient education information, see Digestive Disorders Center, as well as Gastrointestinal Bleeding (GI Bleeding), Rectal Bleeding, Inflammatory Bowel Disease (IBD), Diverticulitis and Diverticulosis, and Anal Abscess.


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