Acute Lower Gastrointestinal Bleeding

  • Jose Castaneda-Nerio
  • Anoop M. NambiarEmail author


Hemodynamically unstable hematochezia is an uncommon manifestation of lower gastrointestinal bleeding. However, acute lower gastrointestinal bleeding can be associated with poor outcomes unless emergent life-saving care is delivered. In this context, early recognition and aggressive resuscitation is essential for a patient presenting with hemodynamically significant hematochezia. Accurate discrimination between upper and lower gastrointestinal sources of hemorrhage is of utmost importance as this has significant implications with respect to prognosis, differential diagnosis, and provides guidance for additional diagnostic testing, such as endoscopy, as well as life-saving therapeutic interventions. Depending on clinical stability and severity of bleeding, diagnosis may require urgent colonoscopy, nuclear red blood cell scan, CT of the abdomen, and/or mesenteric angiography. Colonoscopy and mesenteric angiography may be both diagnostic and therapeutic when performed. Optimal management of a patient with acute lower gastrointestinal bleeding requires consultation and coordination of a multidisciplinary team of expert specialists to improve patient outcomes.


Acute lower gastrointestinal bleeding Hematochezia Diverticulosis Colonoscopy Nuclear red blood cell scan Mesenteric angiography Super-selective embolization 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care Medicine, Department of MedicineUniversity of Texas Health San AntonioSan AntonioUSA
  2. 2.Division of Pulmonary and Critical Care Medicine, Department of MedicineUniversity of Texas Health San Antonio, and the South Texas Veterans Health Care SystemSan AntonioUSA

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