Lower GI hemorrhage can originate from the colon or small bowel. Common causes include bleeding diverticulosis, colonic angiodysplasia, and neoplasms. Evaluation involves laboratory tests, colonoscopy, video capsule endoscopy, or angiography to locate the bleeding site. Treatment options depend on the cause but may include endoscopic therapies, angiographic embolization, or surgery.

1. Lower GI Hemorrhage
ABDWAHID M SALIS,
M.D

2. LGI hemorrhage
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

3. Hematochezia:
Bright red stool, called, is the sign of a fast
moving active GI bleed
Maroon color:
short time taken from the site of the bleed
and the exiting at the anus

4. Causes
Coagulopathy - specifically a bleeding
diathesis

6. Bleeding diverticulosis
Colonic angiodysplasia

7. Diverticulosis – 40-55%
90% stop spontaneously
10% rebleed in 1st
year
and 25% at 4 years

8. Angiodysplasia – 3-20%
– >50 y/o
–>50% are in right colon
argon plasma coagulation

9. Neoplasia
–Typically bleed slowly
–Polyps

10. Inflammatory conditions
15% of UC patients,
1% of chron’s patients
Ischaemic
Radiation
Infectious
AIDS rarely

11. Hemorrhoids
–>50% have hemorrhoids,
– but only 2%
of bleeding
attributed to them

12. Meckels Diverticulum
 The most common cause of massive
bleeding in pediatric patients

13. Evaluation
Same for UGI bleed
If unstable with hematochezia
need EGD 1st

14. Concealed Bleeding
Occasionally, a person with a LGIB will not
present with any signs of internal
bleeding.
 A Diagnostic or pre-assessment:
hypotension, tachycardia, angina, syncope,
weakness, confusion, stroke,
myocardial infarction/heart attack, and shock.

15. Laboratory test
 Hemoglobin, hematocrit, and platelets
 Partial thromboplastin time (PTT) and INR

17. Diagnostics
Colonoscopy
Video capsule endoscopy
Intraoperative endoscopy

18. Selective viseral angiography
Need >0.5 ml/min bleeding
40-75% sensitive if bleeding at time
of exam

19. Tagged RBC scan
Can detect bleeding at 0.1 ml/min

20. Meckel’s scan
Initial test for patients <30 years old

21. Enteroclysis
Ulcerations
Inflammation

22. CT scan
Tumors
 Inflammation
 Diverticuli

23. GI hemorrhage from unknown source
Only 2-5% are not
upper or lower

24. Treatment
Endoscopy:
Theraputic
Angiodysplasia
polypectomy sites

25. Angiographic
– Selective embolization for poor
surgical candidates
– Can lead to ischemic sites
requiring later resection

26. Surgery
Ongoing hemorrhage, >6 units
ongoing transfusion requirement
Site selection
Intraoperative endoscopy
Segmental resection

27. ‫ل‬ ‫الحمد‬