Colonic Bleeding

  • Rachael Lawrence
  • Helen O’Grady


Lower gastrointestinal (GI) hemorrhage is defined as bleeding that originates distal to the ligament of Treitz and accounts for 20–25% of all cases of acute GI hemorrhage. Bleeding may therefore originate from the small bowel in addition to the colon and anorectum. Acute small bowel bleeding is rare and represents a distinct entity. This chapter concentrates on colonic causes of major lower GI hemorrhage. Bleeding of anorectal origin is a common cause of lower GI hemorrhage and can be difficult to differentiate from colonic pathology. The management of anal canal bleeding is discussed in Chap. 2. In addition to an acute or clinically overt hemorrhage, patients with colonic bleeding can present in an occult and chronic manner to the primary care physician and are subsequently referred to the surgical outpatient department. This chapter reviews the etiology, investigation, and management of colonic bleeding in both the outpatient and emergency setting.


Flexible Sigmoidoscopy Argon Plasma Coagulation Scottish Intercollegiate Guideline Network Diverticular Bleeding Acute Gastrointestinal Bleeding 
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  1. 1.
    Barnert J, Messmann H. Diagnosis and management of lower gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol. 2009;6:637–46.PubMedCrossRefGoogle Scholar
  2. 2.
    Vernava III AM, Moore BA, Longo WE, Johnson FE. Lower gastrointestinal bleeding. Dis Colon Rectum. 1997;40(7):846–58.PubMedCrossRefGoogle Scholar
  3. 3.
    Lee J, Costantini TW, Coimbra R. Acute lower GI bleeding for the management for the acute care surgeon: current diagnosis and management review. Scand J Surg. 2009;98:135–42.PubMedGoogle Scholar
  4. 4.
    Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med. 2000;342(2):78–82.PubMedCrossRefGoogle Scholar
  5. 5.
    Bloomfield RS, Rockey DC, Shetzline MA. Endoscopic therapy of acute diverticular hemorrhage. Am J Gastroenterol. 2001;96(8):2367–72.CrossRefGoogle Scholar
  6. 6.
    Li CY, Zhang BL, Chen CX, Li YM. OMOM capsule endoscopy in diagnosis of small bowel disease. J Zhejiang Univ Sci B. 2008;9:857–62.PubMedCrossRefGoogle Scholar
  7. 7.
    Helmrich GA, Stallworth JR, Brown JJ. Angiodysplasia: characterization, diagnosis, and advances in treatment. South Med J. 2000;83:1450–3.CrossRefGoogle Scholar
  8. 8.
    Farrel JJ, Friedman LS. Review article: the management of lower gastrointestinal bleeding. Aliment Pharmacol Ther. 2005;21:1281–98.CrossRefGoogle Scholar
  9. 9.
    Lee LS, Saltzman JR. Acute lower gastrointestinal bleeding. In: Greenberger NJ, Blumberg RS, Burakoff R, editors. Current diagnosis and treatment in gastroenterology, hepatology & endoscopy, Chapter 31. New York: McGraw Hill Lange; 2009. p. 343–51.Google Scholar
  10. 10.
    The National Institute for Health and Clinical Excellence (NICE). Guidelines on referral for suspected cancer. October 2010,
  11. 11.
    Thompson JA, Pond CL, Ellis BG, Beach A, Thompson MR. Rectal bleeding in general and hospital practice: ‘the tip of the iceberg’. Colorectal Dis. 2000;2:288–93.CrossRefGoogle Scholar
  12. 12.
    Mathew J, Shankar P, Aldean IM. Audit on flexible sigmoidoscopy for rectal bleeding in a district general hospital: are we overloading the resources? Postgrad Med J. 2004;80:38–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Scottish Intercollegiate Guidelines Network (SIGN). Management of acute upper and lower gastrointestinal bleeding: a national clinical guideline. 2008. October 2010,
  14. 14.
    Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia: the role of urgent colonoscopy after purge. Gastroenterology. 1988;95(6):1569–74.PubMedGoogle Scholar
  15. 15.
    Edelman DA, Sugawa C. Lower gastrointestinal bleeding: a review. Surg Endosc. 2007;21:514–20.PubMedCrossRefGoogle Scholar
  16. 16.
    Strate LL, Syngal S. Timing of colonoscopy: impact on length of hospital stay in patients with acute lower intestinal bleeding. Am J Gastroenterol. 2003;98(2):317–22.PubMedGoogle Scholar
  17. 17.
    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.PubMedGoogle Scholar
  18. 18.
    Adams JB, Margolin MD. Management of diverticular hemorrhage. Clin Colon Rectal Surg. 2009;22(3):181–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Zuccaro G. Management of the adult patient with acute lower gastrointestinal bleeding. Am J Gastroenterol. 1998;93:1202–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Chaudry V, Hyser MJ, Gracias VH, Gau FC. Colonoscopy: the initial test for acute lower gastrointestinal bleeding. Am Surg. 1998;64(8):723–8.Google Scholar
  21. 21.
    Davila RE, et al. ASGE guideline: the role of endoscopy in the patient with lower-GI bleeding. Gastrointest Endosc. 2005;62:656–60.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    Yoon W, Jeong YY, Shin SS, Lim HS, Song SG, Jang NG, Kim JK, Kang HK. Acute massive gastrointestinal bleeding: detection and localisation with arterial phase multi-detector row helical CT. Radiology. 2006;239:160–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Olds GD, Cooper GS, Chak A, Sivak Jr MV, Chitale AA, Wong RC. The yield of bleeding scans in acute lower gastrointestinal hemorrhage. J Clin Gastroenterol. 2005;39(4):273–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Ohyama T, Sakurai Y, Ito M, Daito K, Sezai S, Sato Y. Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding. Digestion. 2000;61(3):189–92.PubMedCrossRefGoogle Scholar
  26. 26.
    Rex DK, Lewis BS, Waye JD. Colonoscopy and endoscopic therapy for delayed post-polypectomy hemorrhage. Gastrointest Endosc. 1992;38(2):127–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Parra-Blanco A, Kaminaga N, Kojima T, Endo Y, Uragami N, Okawa N, et al. Hemoclipping for postpolypectomy and postbiopsy colonic bleeding. Gastrointest Endosc. 2000;51(1):37–41.PubMedCrossRefGoogle Scholar
  28. 28.
    Hochter W, Weingart J, Kuhner W, Frimberger E, Ottenjann R. Angiodysplasia in the colon and rectum: endoscopic morphology, localisation and frequency. Endoscopy. 1985;17:182–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Foutch PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol. 1993;88:807–18.PubMedGoogle Scholar
  30. 30.
    Kwan V, et al. Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up. Am J Gastroenterol. 2006;101:58–63.PubMedCrossRefGoogle Scholar
  31. 31.
    Funkani B, Kostelic JK, Lorenz J, et al. Superselective microcoil embolization of colonic haemorrhage. AJR Am J Roentgenol. 2001;177(4):829–36.Google Scholar
  32. 32.
    Khana A, Ognibene SJ, Koniaris LG. Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding: evidence from a meta-analysis. J Gastrointest Surg. 2005;9(3):343–52.CrossRefGoogle Scholar
  33. 33.
    d’Othee BJ, Surapaneni P, Rabkin D, Nasser I, Clouse M. Microcoil embolization for acute lower gastrointestinal bleeding. Cardiovasc Intervent Radiol. 2006;29(1):49–58.PubMedCrossRefGoogle Scholar
  34. 34.
    Czymek R, et al. Surgical treatment concepts for acute lower gastrointestinal bleeding. J Gastrointest Surg. 2008;12:2212–20.PubMedCrossRefGoogle Scholar
  35. 35.
    Hoedema RF, Luchtefield MA. The management of lower gastrointestinal haemorrhage. Dis Colon Rectum. 2005;48:2010–24.PubMedCrossRefGoogle Scholar
  36. 36.
    McGuire HH. Bleeding colonic diverticula: a reappraisal of natural history and management. Ann Surg. 1994;220:653–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Scott HJ, Lane IF, Glynn MJ, et al. Colonic haemorrhage: a technique for rapid intra-operative bowel preparation and colonoscopy. Br J Surg. 1986;73:390–1.PubMedCrossRefGoogle Scholar
  38. 38.
    Farner R, Lichliter W, Kuhn J, Fisher T. Total colectomy versus limited colonic resection for acute lower gastrointestinal bleeding. Am J Surg. 1999;178(6):587–91.PubMedCrossRefGoogle Scholar
  39. 39.
    Baker R, Senagore A. Abdominal colectomy offers safe management for massive lower GI bleed. Am Surg. 1994;60(8):578–82.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Castle Hill HospitalThe University of Hull Academic Surgical UnitHullUK

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