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Acute Lower Gastrointestinal Hemorrhage

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The Acute Management of Surgical Disease

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Abstract

A 65-year-old male presents with hematochezia. Symptoms began 1 week ago and have been intermittent. Earlier today he became lightheaded and nauseated, prompting his presentation to the emergency room.

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References

  1. Peura DA, Lanza FL, Gostout CJ, Foutch PG. The American College of Gastroenterology Bleeding Registry: preliminary findings. Am J Gastroenterol. 1997;92(6):924–8.

    CAS  PubMed  Google Scholar 

  2. Gostout C. Acute lower GI bleeding. In: Brandt L, editor. Current medicine clinical practice of gastroenterology. Philadelphia, PA: Churchill Livingstone; 1998. p. 651–62.

    Google Scholar 

  3. Zuccaro G. Management of the adult patient with acute lower gastrointestinal bleeding. American College of Gastroenterology. Practice Parameters Committee. Am J Gastroenterol. 1998;93(8):1202–8.

    Article  PubMed  Google Scholar 

  4. Proctor DD. Critical issues in digestive diseases. Clin Chest Med. 2003;24(4):623–32.

    Article  PubMed  Google Scholar 

  5. Bramley PN, Masson JW, McKnight G, Herd K, Fraser A, Park K, et al. The role of an open-access bleeding unit in the management of colonic haemorrhage. A 2-year prospective study. Scand J Gastroenterol. 1996;31(8):764–9.

    Article  CAS  PubMed  Google Scholar 

  6. Feinman M, Haut ER. Lower gastrointestinal bleeding. Surg Clin N Am. 2014;94(1):55–63.

    Article  PubMed  Google Scholar 

  7. Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997;92(3):419–24.

    CAS  PubMed  Google Scholar 

  8. Mujica VR, Barkin JS. Occult gastrointestinal bleeding. General overview and approach. Gastrointest Endosc Clin N Am. 1996;6(4):833–45.

    Article  CAS  PubMed  Google Scholar 

  9. Laine L, Connors LG, Reicin A, Hawkey CJ, Burgos-Vargas R, Schnitzer TJ, et al. Serious lower gastrointestinal clinical events with nonselective NSAID or coxib use. Gastroenterology. 2003;124(2):288–92.

    Article  CAS  PubMed  Google Scholar 

  10. Lin CC, Lee YC, Lee H, Lin JT, Ho WC, Chen TH, et al. Bedside colonoscopy for critically ill patients with acute lower gastrointestinal bleeding. Intensive Care Med. 2005;31(5):743–6.

    Article  PubMed  Google Scholar 

  11. Bhatti N, Amoateng-Adjepong Y, Qamar A, Manthous CA. Myocardial infarction in critically ill patients presenting with gastrointestinal hemorrhage: retrospective analysis of risks and outcomes. Chest. 1998;114(4):1137–42.

    Article  CAS  PubMed  Google Scholar 

  12. Bellotto F, Fagiuoli S, Pavei A, Gregory SA, Cati A, Silverj E, et al. Anemia and ischemia: myocardial injury in patients with gastrointestinal bleeding. Am J Med. 2005;118(5):548–51.

    Article  PubMed  Google Scholar 

  13. Cappell MS. A study of the syndrome of simultaneous acute upper gastrointestinal bleeding and myocardial infarction in 36 patients. Am J Gastroenterol. 1995;90(9):1444–9.

    CAS  PubMed  Google Scholar 

  14. Cappell MS. Gastrointestinal bleeding associated with myocardial infarction. Gastroenterol Clin N Am. 2000;29(2):423–44, vi.

    Article  CAS  Google Scholar 

  15. Cappell MS. Risks versus benefits of flexible sigmoidoscopy after myocardial infarction: an analysis of 78 patients at three medical centers. Am J Med. 2004;116(10):707–10.

    Article  PubMed  Google Scholar 

  16. Foutch PG. Diverticular bleeding: are nonsteroidal anti-inflammatory drugs risk factors for hemorrhage and can colonoscopy predict outcome for patients? Am J Gastroenterol. 1995;90(10):1779–84.

    CAS  PubMed  Google Scholar 

  17. Meyers MA, Alonso DR, Baer JW. Pathogenesis of massively bleeding colonic diverticulosis: new observations. AJR Am J Roentgenol. 1976;127(6):901–8.

    Article  CAS  PubMed  Google Scholar 

  18. Boley SJ, Brandt LJ. Vascular ectasias of the colon—1986. Dig Dis Sci. 1986;31(9 Suppl):26S–42S.

    Article  CAS  PubMed  Google Scholar 

  19. Boley SJ, DiBiase A, Brandt LJ, Sammartano RJ. Lower intestinal bleeding in the elderly. Am J Surg. 1979;137(1):57–64.

    Article  CAS  PubMed  Google Scholar 

  20. Welch CE, Athanasoulis CA, Galdabini JJ. Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease. World J Surg. 1978;2(1):73–83.

    Article  CAS  PubMed  Google Scholar 

  21. Rogers BH. Endoscopic diagnosis and therapy of mucosal vascular abnormalities of the gastrointestinal tract occurring in elderly patients and associated with cardiac, vascular, and pulmonary disease. Gastrointest Endosc. 1980;26(4):134–8.

    Article  CAS  PubMed  Google Scholar 

  22. Marcuard SP, Weinstock JV. Gastrointestinal angiodysplasia in renal failure. J Clin Gastroenterol. 1988;10(5):482–4.

    Article  CAS  PubMed  Google Scholar 

  23. Imperiale TF, Ransohoff DF. Aortic stenosis, idiopathic gastrointestinal bleeding, and angiodysplasia: is there an association? A methodologic critique of the literature. Gastroenterology. 1988;95(6):1670–6.

    Article  CAS  PubMed  Google Scholar 

  24. Höchter W, Weingart J, Kühner W, Frimberger E, Ottenjann R. Angiodysplasia in the colon and rectum. Endoscopic morphology, localisation and frequency. Endoscopy. 1985;17(5):182–5.

    Article  PubMed  Google Scholar 

  25. Newman JR, Cooper MA. Lower gastrointestinal bleeding and ischemic colitis. Can J Gastroenterol. 2002;16(9):597–600.

    Article  PubMed  Google Scholar 

  26. Pardi DS, Loftus EV, Tremaine WJ, Sandborn WJ, Alexander GL, Balm RK, et al. Acute major gastrointestinal hemorrhage in inflammatory bowel disease. Gastrointest Endosc. 1999;49(2):153–7.

    Article  CAS  PubMed  Google Scholar 

  27. Vernava AM, Moore BA, Longo WE, Johnson FE. Lower gastrointestinal bleeding. Dis Colon Rectum. 1997;40(7):846–58.

    Article  PubMed  Google Scholar 

  28. Takeuchi K, Tsuzuki Y, Ando T, Sekihara M, Hara T, Ohno Y, et al. Clinical characteristics of acute hemorrhagic rectal ulcer. J Clin Gastroenterol. 2001;33(3):226–8.

    Article  CAS  PubMed  Google Scholar 

  29. Hung HY, Changchien CR, You JF, Chen JS, Chiang JM, Yeh CY, et al. Massive hematochezia from acute hemorrhagic rectal ulcer in patients with severe comorbid illness: rapid control of bleeding by per anal suturing of bleeder using anoretractor. Dis Colon Rectum. 2006;49(2):238–43.

    Article  PubMed  Google Scholar 

  30. Bjarnason I, Hayllar J, MacPherson AJ, Russell AS. Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans. Gastroenterology. 1993;104(6):1832–47.

    Article  CAS  PubMed  Google Scholar 

  31. Franko E, Chardavoyne R, Wise L. Massive rectal bleeding from a Dieulafoy’s type ulcer of the rectum: a review of this unusual disease. Am J Gastroenterol. 1991;86(10):1545–7.

    CAS  PubMed  Google Scholar 

  32. Abdulian JD, Santoro MJ, Chen YK, Collen MJ. Dieulafoy-like lesion of the rectum presenting with exsanguinating hemorrhage: successful endoscopic sclerotherapy. Am J Gastroenterol. 1993;88(11):1939–41.

    CAS  PubMed  Google Scholar 

  33. Suzuki S, Chino A, Kishihara T, Uragami N, Tamegai Y, Suganuma T, et al. Risk factors for bleeding after endoscopic submucosal dissection of colorectal neoplasms. World J Gastroenterol. 2014;20(7):1839–45.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Strate LL. Lower GI bleeding: epidemiology and diagnosis. Gastroenterol Clin N Am. 2005;34(4):643–64.

    Article  Google Scholar 

  35. Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. Gastroenterology. 1988;95(6):1569–74.

    Article  CAS  PubMed  Google Scholar 

  36. Laine L, Shah A. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol. 2010;105(12):2636–41; quiz 42.

    Article  PubMed  Google Scholar 

  37. van Cutsem E, Rutgeerts P, Vantrappen G. Treatment of bleeding gastrointestinal vascular malformations with oestrogen-progesterone. Lancet. 1990;335(8695):953–5.

    Article  PubMed  Google Scholar 

  38. Barkin JS, Ross BS. Medical therapy for chronic gastrointestinal bleeding of obscure origin. Am J Gastroenterol. 1998;93(8):1250–4.

    Article  CAS  PubMed  Google Scholar 

  39. Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111(5):755.

    Article  PubMed  Google Scholar 

  40. Tada M, Shimizu S, Kawai K. Emergency colonoscopy for the diagnosis of lower intestinal bleeding. Gastroenterol Jpn. 1991;26(Suppl 3):121–4.

    Article  PubMed  Google Scholar 

  41. Vellacott KD. Early endoscopy for acute lower gastrointestinal haemorrhage. Ann R Coll Surg Engl. 1986;68(5):243–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Green BT, Rockey DC, Portwood G, Tarnasky PR, Guarisco S, Branch MS, et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol. 2005;100(11):2395–402.

    Article  PubMed  Google Scholar 

  43. Rockey DC. Lower gastrointestinal bleeding. Gastroenterology. 2006;130(1):165–71.

    Article  PubMed  Google Scholar 

  44. Strate LL, Naumann CR. The role of colonoscopy and radiological procedures in the management of acute lower intestinal bleeding. Clin Gastroenterol Hepatol. 2010;8(4):333–43; quiz e44.

    Article  PubMed  Google Scholar 

  45. Zuckerman GR, Prakash C. Acute lower intestinal bleeding: part I: clinical presentation and diagnosis. Gastrointest Endosc. 1998;48(6):606–17.

    Article  CAS  PubMed  Google Scholar 

  46. Edelman DA, Sugawa C. Lower gastrointestinal bleeding: a review. Surg Endosc. 2007;21(4):514–20.

    Article  PubMed  Google Scholar 

  47. Leitman IM, Paull DE, Shires GT. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg. 1989;209(2):175–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg. 1986;204(5):530–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Britt LG, Warren L, Moore OF. Selective management of lower gastrointestinal bleeding. Am Surg. 1983;49(3):121–5.

    CAS  PubMed  Google Scholar 

  50. Pennoyer WP, Vignati PV, Cohen JL. Mesenteric angiography for lower gastrointestinal hemorrhage: are there predictors for a positive study? Dis Colon Rectum. 1997;40(9):1014–8.

    Article  CAS  PubMed  Google Scholar 

  51. Miller M, Smith TP. Angiographic diagnosis and endovascular management of nonvariceal gastrointestinal hemorrhage. Gastroenterol Clin N Am. 2005;34(4):735–52.

    Article  Google Scholar 

  52. Rosenkrantz H, Bookstein JJ, Rosen RJ, Goff WB, Healy JF. Postembolic colonic infarction. Radiology. 1982;142(1):47–51.

    Article  CAS  PubMed  Google Scholar 

  53. Guy GE, Shetty PC, Sharma RP, Burke MW, Burke TH. Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particles. AJR Am J Roentgenol. 1992;159(3):521–6.

    Article  CAS  PubMed  Google Scholar 

  54. Funaki B. Endovascular intervention for the treatment of acute arterial gastrointestinal hemorrhage. Gastroenterol Clin N Am. 2002;31(3):701–13.

    Article  Google Scholar 

  55. Gordon RL, Ahl KL, Kerlan RK, Wilson MW, LaBerge JM, Sandhu JS, et al. Selective arterial embolization for the control of lower gastrointestinal bleeding. Am J Surg. 1997;174(1):24–8.

    Article  CAS  PubMed  Google Scholar 

  56. Luchtefeld MA, Senagore AJ, Szomstein M, Fedeson B, Van Erp J, Rupp S. Evaluation of transarterial embolization for lower gastrointestinal bleeding. Dis Colon Rectum. 2000;43(4):532–4.

    Article  CAS  PubMed  Google Scholar 

  57. Egglin TK, O’Moore PV, Feinstein AR, Waltman AC. Complications of peripheral arteriography: a new system to identify patients at increased risk. J Vasc Surg. 1995;22(6):787–94.

    Article  CAS  PubMed  Google Scholar 

  58. Spiller RC, Parkins RA. Recurrent gastrointestinal bleeding of obscure origin: report of 17 cases and a guide to logical management. Br J Surg. 1983;70(8):489–93.

    Article  CAS  PubMed  Google Scholar 

  59. Thompson JN, Salem RR, Hemingway AP, Rees HC, Hodgson HJ, Wood CB, et al. Specialist investigation of obscure gastrointestinal bleeding. Gut. 1987;28(1):47–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Raju GS, Gerson L, Das A, Lewis B, Association AG. American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding. Gastroenterology. 2007;133(5):1697–717.

    Article  PubMed  Google Scholar 

  61. Zaman A, Katon RM. Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope. Gastrointest Endosc. 1998;47(5):372–6.

    Article  CAS  PubMed  Google Scholar 

  62. Descamps C, Schmit A, Van Gossum A. “Missed” upper gastrointestinal tract lesions may explain “occult” bleeding. Endoscopy. 1999;31(6):452–5.

    Article  CAS  PubMed  Google Scholar 

  63. Farrands PA, Taylor I. Management of acute lower gastrointestinal haemorrhage in a surgical unit over a 4-year period. J R Soc Med. 1987;80(2):79–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Wagner HE, Stain SC, Gilg M, Gertsch P. Systematic assessment of massive bleeding of the lower part of the gastrointestinal tract. Surg Gynecol Obstet. 1992;175(5):445–9.

    CAS  PubMed  Google Scholar 

  65. Junquera F, Quiroga S, Saperas E, Pérez-Lafuente M, Videla S, Alvarez-Castells A, et al. Accuracy of helical computed tomographic angiography for the diagnosis of colonic angiodysplasia. Gastroenterology. 2000;119(2):293–9.

    Article  CAS  PubMed  Google Scholar 

  66. Taylor AC, Chen RY, Desmond PV. Use of an overtube for enteroscopy—does it increase depth of insertion? A prospective study of enteroscopy with and without an overtube. Endoscopy. 2001;33(3):227–30.

    Article  CAS  PubMed  Google Scholar 

  67. Lin S, Branch MS, Shetzline M. The importance of indication in the diagnostic value of push enteroscopy. Endoscopy. 2003;35(4):315–21.

    Article  CAS  PubMed  Google Scholar 

  68. Yamamoto H, Kita H, Sunada K, Hayashi Y, Sato H, Yano T, et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol. 2004;2(11):1010–6.

    Article  PubMed  Google Scholar 

  69. May A, Nachbar L, Ell C. Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease. Gastrointest Endosc. 2005;62(1):62–70.

    Article  PubMed  Google Scholar 

  70. Hartmann D, Schmidt H, Bolz G, Schilling D, Kinzel F, Eickhoff A, et al. A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding. Gastrointest Endosc. 2005;61(7):826–32.

    Article  PubMed  Google Scholar 

  71. Adler DG, Knipschield M, Gostout C. A prospective comparison of capsule endoscopy and push enteroscopy in patients with GI bleeding of obscure origin. Gastrointest Endosc. 2004;59(4):492–8.

    Article  PubMed  Google Scholar 

  72. Carey EJ, Fleischer DE. Investigation of the small bowel in gastrointestinal bleeding—enteroscopy and capsule endoscopy. Gastroenterol Clin N Am. 2005;34(4):719–34.

    Article  Google Scholar 

  73. Gerson LB, Fidler JL, Cave DR, Leighton JA. ACG clinical guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol. 2015;110(9):1265–87; quiz 88.

    Article  CAS  PubMed  Google Scholar 

  74. Pennazio M, Spada C, Eliakim R, Keuchel M, May A, Mulder CJ, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2015;47(4):352–76.

    Article  PubMed  Google Scholar 

  75. Awais M, Haq TU, Rehman A, Zaman MU, Haider Z, Khattak YJ, et al. Accuracy of 99mTechnetium-labeled RBC scintigraphy and MDCT with gastrointestinal bleed protocol for detection and localization of source of acute lower gastrointestinal bleeding. J Clin Gastroenterol. 2016;50(9):754–60.

    Article  CAS  PubMed  Google Scholar 

  76. Currie GM, Kiat H, Wheat JM. Scintigraphic evaluation of acute lower gastrointestinal hemorrhage: current status and future directions. J Clin Gastroenterol. 2011;45(2):92–9.

    Article  PubMed  Google Scholar 

  77. Hunter JM, Pezim ME. Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding. Am J Surg. 1990;159(5):504–6.

    Article  CAS  PubMed  Google Scholar 

  78. Levy R, Barto W, Gani J. Retrospective study of the utility of nuclear scintigraphic-labelled red cell scanning for lower gastrointestinal bleeding. ANZ J Surg. 2003;73(4):205–9.

    Article  PubMed  Google Scholar 

  79. Rantis PC, Harford FJ, Wagner RH, Henkin RE. Technetium-labelled red blood cell scintigraphy: is it useful in acute lower gastrointestinal bleeding? Int J Color Dis. 1995;10(4):210–5.

    Article  Google Scholar 

  80. Garofalo TE, Abdu RA. Accuracy and efficacy of nuclear scintigraphy for the detection of gastrointestinal bleeding. Arch Surg. 1997;132(2):196–9.

    Article  CAS  PubMed  Google Scholar 

  81. Kong MS, Chen CY, Tzen KY, Huang MJ, Wang KL, Lin JN. Technetium-99m pertechnetate scan for ectopic gastric mucosa in children with gastrointestinal bleeding. J Formos Med Assoc. 1993;92(8):717–20.

    CAS  PubMed  Google Scholar 

  82. Sfakianakis GN, Conway JJ. Detection of ectopic gastric mucosa in Meckel’s diverticulum and in other aberrations by scintigraphy: II. Indications and methods—a 10-year experience. J Nucl Med. 1981;22(8):732–8.

    CAS  PubMed  Google Scholar 

  83. Lin S, Rockey DC. Obscure gastrointestinal bleeding. Gastroenterol Clin N Am. 2005;34(4):679–98.

    Article  Google Scholar 

  84. Kim CY, Suhocki PV, Miller MJ, Khan M, Janus G, Smith TP. Provocative mesenteric angiography for lower gastrointestinal hemorrhage: results from a single-institution study. J Vasc Interv Radiol. 2010;21(4):477–83.

    Article  PubMed  Google Scholar 

  85. Marion Y, Lebreton G, Le Pennec V, Hourna E, Viennot S, Alves A. The management of lower gastrointestinal bleeding. J Visc Surg. 2014;151(3):191–201.

    Article  CAS  PubMed  Google Scholar 

  86. McGuire HH, Haynes BW. Massive hemorrhage for diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in fifty cases. Ann Surg. 1972;175(6):847–55.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Parkes BM, Obeid FN, Sorensen VJ, Horst HM, Fath JJ. The management of massive lower gastrointestinal bleeding. Am Surg. 1993;59(10):676–8.

    CAS  PubMed  Google Scholar 

  88. Setya V, Singer JA, Minken SL. Subtotal colectomy as a last resort for unrelenting, unlocalized, lower gastrointestinal hemorrhage: experience with 12 cases. Am Surg. 1992;58(5):295–9.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Amelia Walling Maiga

  2. LifeFlight Air Medical Program, Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Bradley M. Dennis

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  1. Amelia Walling Maiga
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Correspondence to Bradley M. Dennis .

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Editors and Affiliations

  1. Trauma and Acute Care Surgery, Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Martin D. Zielinski

  2. Trauma and Surgical Care Clinic, Vanderbilt University, Nashville, TN, USA

    Oscar Guillamondegui

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Maiga, A.W., Dennis, B.M. (2022). Acute Lower Gastrointestinal Hemorrhage. In: Zielinski, M.D., Guillamondegui, O. (eds) The Acute Management of Surgical Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-07881-1_32

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