Management of Lower Gastrointestinal Bleeding

  • Audrey S. Kulaylat
  • David B. StewartJr.Email author


Lower gastrointestinal bleeding (LGIB) can manifest as low-volume bleeding or life-threatening hemorrhage. Early resuscitation and determination of the cause of bleeding are the key steps in the initial management of LGIB. Slower, self-limiting bleeding episodes can be evaluated by endoscopic intervention, whereas persistent or recurrent bleeding should be evaluated with CT angiography or nuclear scintigraphy. Operative intervention without prior localization of the LGIB should be reserved for patients with unremitting and life-threatening bleeding, or for those who continue to experience recurrent bleeding, and should involve a total abdominal colectomy.


Gastrointestinal bleeding Diverticulosis Angiography Colonoscopy 


  1. 1.
    Steele SR, Hull T, Read TE, Saclarides TJ, Senagore AJ, Whitelow CB, editors. The ASCRS textbook of colon and rectal surgery. 3rd ed. Arlington Heights: Springer; 2016.Google Scholar
  2. 2.
    Strate LL, Gralnek IM. Management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111(4):459–74.CrossRefGoogle Scholar
  3. 3.
    Pasha SF, Shergill A, Acosta RD, et al. The role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc. 2014;79(6):875–85.CrossRefGoogle Scholar
  4. 4.
    Strate LL, Naumann CR. The role of colonoscopy and radiological procedures in the management of acute lower intestinal bleeding. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2010;8(4):333–43; quiz e344.Google Scholar
  5. 5.
    Koh FH, Soong J, Lieske B, Cheong WK, Tan KK. Does the timing of an invasive mesenteric angiography following a positive CT mesenteric angiography make a difference? Int J Color Dis. 2015;30(1):57–61.CrossRefGoogle Scholar
  6. 6.
    Ng DA, Opelka FG, Beck DE, et al. Predictive value of technetium Tc 99m-labeled red blood cell scintigraphy for positive angiogram in massive lower gastrointestinal hemorrhage. Dis Colon Rectum. 1997;40(4):471–7.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryPenn State Milton S. Hershey Medical CenterHersheyUSA
  2. 2.Department of SurgeryBanner University Medical Center – TucsonTucsonUSA

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