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Acute Gastrointestinal Bleeding pp 199–218Cite as

Obscure Causes of Acute Lower Gastrointestinal Bleeding

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Part of the book series: Clinical Gastroenterology ((CG))

Abstract

In contrast to chronic or occult bleeding, acute lower gastrointestinal (GI) bleeding can be a confusing conundrum and a diagnostic dilemma. The difficulty is exacerbated by the severity and rapidity of the clinical problem, since by definition it involves instability of vital signs, anemia, and/or the need for blood transfusion (1). Unfortunately, the diagnostic and therapeutic approach to the patient with severe lower GI bleeding has not been well standardized. The clinician cannot rely on generally accepted guidelines, since there is a paucity of evidence-based recommendations. This uncertainty is an unavoidable fact that can be uncomfortable for the primary care physician and anxious patients or family who have unrealistic expectations that definitive diagnosis and treatment may be possible even in this situation. Many patients with unrevealing colonoscopy, radiology, and nuclear medicine scans are simply transfused, with the hope that their bleeding will stop spontaneously and not recur after discharge. Unfortunately, in about 20% of patients, bleeding recurs or continues. In many cases an empiric resection of some or the entire colon is done, but the mortality is high in these typically elderly patients. Many who survive such surgery continue bleeding, especially if only a partial resection is performed.

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References

  1. Zuckerman GR, Prakash C. Acute lower intestinal bleeding: part I: clinical presentation and diagnosis. Gastrointest Endosc 1998; 48: 606–617.

    Article  PubMed  CAS  Google Scholar 

  2. Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. Gastroenterology 1988; 95: 1569–1574.

    PubMed  CAS  Google Scholar 

  3. Cuellar RE, Gavaler JS, Alexander JA, et al. Gastrointestinal tract hemorrhage. The value of a nasogastric aspirate. Arch Intern Med 1990; 150: 1381–1384.

    Article  PubMed  CAS  Google Scholar 

  4. Caos A, Benner KG, Manier J, et al. Colonoscopy after Golytely preparation in acute rectal bleeding. J Clin Gastroenterol 1986; 8: 46–49.

    Article  PubMed  CAS  Google Scholar 

  5. Richter JM, Christensen MR, Kaplan LM, Nishioka NS. Effectiveness of current technology in the diagnosis and management of lower gastrointestinal hemorrhage. Gastrointest Endosc 1995; 41: 93–98.

    Article  PubMed  CAS  Google Scholar 

  6. Hixson LJ, Sampliner RE, Chemin M, Amberg J, Kogan F. Limitations of combined flexible sigmoidoscopy and double contrast barium enema in patients with rectal bleeding. Eur J Radiol 1989; 9: 254–257.

    PubMed  CAS  Google Scholar 

  7. Rossini FP, Ferrari A, Spandre M, et al. Emergency colonoscopy. World J Surg 1989; 13: 190–192.

    Article  PubMed  CAS  Google Scholar 

  8. Forde KA. Colonoscopy in acute rectal bleeding. Gastrointest Endosc 1981; 27: 219–220.

    Article  PubMed  CAS  Google Scholar 

  9. Zuccaro G Jr. Management of the adult patient with acute lower gastrointestinal bleeding. American College of Gastroenterology. Practice Parameters Committee. Am J Gastroenterol 1998; 93: 1202–1208.

    PubMed  Google Scholar 

  10. Jensen DM, Machicado GA. Colonoscopy for diagnosis and treatment of severe lower gastrointestinal bleeding. Routine outcomes and cost analysis. Gastrointest Endosc Clin North Am 1997; 7: 477–498.

    CAS  Google Scholar 

  11. Alavi A, Ring EJ. Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography. AJR Am J Roentgenol 1981; 137: 741–748.

    PubMed  CAS  Google Scholar 

  12. Gupta S, Luna E, Kingsley S, Prince M, Herrera N. Detection of gastrointestinal bleeding by radionuclide scintigraphy. Am J Gastroenterol 1984; 79: 26–31.

    PubMed  CAS  Google Scholar 

  13. Bentley DE, Richardson JD. The role of tagged red blood cell imaging in the localization of gastrointestinal bleeding. Arch Surg 1991; 126: 821–824.

    Article  PubMed  CAS  Google Scholar 

  14. Bunker SR, Lull RJ, Tanasescu DE, et al. Scintigraphy of gastrointestinal hemorrhage: superiority of 99mTc red blood cells over 99mTc sulfur colloid. AJR Am J Roentgenol 1984; 143: 543–548.

    PubMed  CAS  Google Scholar 

  15. Leitman IM, Paull DE, Shires GT, 3rd. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg 1989; 209: 175–180.

    Article  PubMed  CAS  Google Scholar 

  16. Colacchio TA, Forde KA, Patsos TJ, Nunez D. Impact of modern diagnostic methods on the management of active rectal bleeding. Ten year experience. Am J Surg 1982; 143: 607–610.

    Article  PubMed  CAS  Google Scholar 

  17. Britt LG, Warren L, Moore OF, 3rd. Selective management of lower gastrointestinal bleeding. Am Surg 1983; 49: 121–125.

    PubMed  CAS  Google Scholar 

  18. Lewis BS. Small intestinal bleeding. Gastroenterol Clin North Am 2000; 29: 6795, vi.

    Google Scholar 

  19. Smith R, Copely DJ, Bolen FH. 99mTc RBC scintigraphy: correlation of gastrointestinal bleeding rates with scintigraphic findings. AJR Am J Roentgenol 1987; 148: 869–874.

    PubMed  CAS  Google Scholar 

  20. Rantis PC Jr, Harford FJ, Wagner RH, Henkin RE. Technetium-labelled red blood cell scintigraphy: is it useful in acute lower gastrointestinal bleeding? Int J Colorectal Dis 1995; 10: 210–215.

    Article  PubMed  Google Scholar 

  21. Zuckerman DA, Bocchini TP, Birnbaum EH. Massive hemorrhage in the lower gastrointestinal tract in adults: diagnostic imaging and intervention. AJR Am J Roentgenol 1993; 161: 703–711.

    PubMed  CAS  Google Scholar 

  22. Hilfiker PR, Zimmermann-Paul GG, Schmidt M, Klotz HP, Kacl GM, Debatin JF. Intestinal and peritoneal bleeding: detection with an intravascular contrast agent and fast three-dimensional MR imaging-preliminary experience from an experimental study. Radiology 1998; 209: 769–774:

    Google Scholar 

  23. Ettorre GC, Francioso G, Garribba AP, Fracella MR, Greco A, Farchi G. Helical CT angiography in gastrointestinal bleeding of obscure origin. AJR Am J Roentgenol 1997; 168: 727–731.

    PubMed  CAS  Google Scholar 

  24. Weaver GA, Alpern HD, Davis JS, Ramsey WH, Reichelderfer M. Gastrointestinal angiodysplasia associated with aortic valve disease: part of a spectrum of angiodysplasia of the gut. Gastroenterology 1979; 77: 1–11.

    PubMed  CAS  Google Scholar 

  25. Reichelderfer M, Morrissey JF. Colonoscopy in radiation colitis. Gastrointest Endosc 1980; 26: 41–43.

    Article  PubMed  CAS  Google Scholar 

  26. Boley SJ, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S. On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology 1977; 72: 650–660.

    PubMed  CAS  Google Scholar 

  27. Reinus JF, Brandt LJ. Vascular ectasias and diverticulosis. Common causes of lower intestinal bleeding. Gastroenterol Clin North Am 1994; 23: 1–20.

    PubMed  CAS  Google Scholar 

  28. Salem RR, Wood CB, Rees HC, Kheshavarzian A, Hemingway AP, Allison DJ. A comparison of colonoscopy and selective visceral angiography in the diagnosis of colonic angiodysplasia. Ann R Coll Surg Engl 1985; 67: 225–226.

    PubMed  CAS  Google Scholar 

  29. Krevsky B. Detection and treatment of angiodysplasia. Gastrointest Endosc Clin North Am 1997; 7: 509–524.

    CAS  Google Scholar 

  30. Shapeero LG, Myers A, Oberkircher PE, Miller WT. Acute reversible lupus vasculitis of the gastrointestinal tract. Radiology 1974; 112: 569–574.

    PubMed  CAS  Google Scholar 

  31. Korn JE, Weaver GA. Vasculitis of the colon diagnosed by colonoscopy. Gastrointest Endosc 1979; 25: 156–158.

    Article  PubMed  CAS  Google Scholar 

  32. Morichau-Beauchant M, Touchard G, Maire P, et al. Jejunal IgA and C3 deposition in adult Henoch-Schönlein purpura with severe intestinal manifestations. Gastroenterology 1982; 82: 1438–1442.

    PubMed  CAS  Google Scholar 

  33. Ricci RL, Lee KR, Greenberger NJ. Chronic gastrointestinal bleeding from ileal varices after total proctocolectomy for ulcerative colitis: correction by mesocaval shunt. Gastroenterology 1980; 78: 1053–1058.

    PubMed  CAS  Google Scholar 

  34. Hamlyn AN, Morris JS, Lunzer MR, Puritz H, Dick R. Portal hypertension with varices in unusual sites. Lancet 1974; 2: 1531–1534.

    Article  PubMed  CAS  Google Scholar 

  35. Kozarek RA, Botoman VA, Bredfeldt JE, Roach JM, Patterson DJ, Ball TJ. Portal colopathy: prospective study of colonoscopy in patients with portal hypertension. Gastroenterology 1991; 101: 1192–1197.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  37. Vane DW, West KW, Grosfeld JL. Vitelline duct anomalies. Experience with 217 childhood cases. Arch Surg 1987; 122: 542–547.

    Article  PubMed  CAS  Google Scholar 

  38. Sfakianakis GN, Conway JJ. Detection of ectopic gastric mucosa in Meckel’s diverticulum and in other aberrations by scintigraphy: I. Pathophysiology and 10-year clinical experience. J Nuc] Med 1981; 22: 647–654.

    CAS  Google Scholar 

  39. Tedesco FJ, Waye JD, Raskin JB, Morris SJ, Greenwald RA. Colonoscopic evaluation of rectal bleeding: a study of 304 patients. Ann Intern Med 1978; 89: 907–909.

    PubMed  CAS  Google Scholar 

  40. Pardi DS, Loftus EV Jr, Tremaine WJ, et al. Acute major gastrointestinal hemorrhage in inflammatory bowel disease. Gastrointest Endosc 1999; 49: 153–157.

    Article  PubMed  CAS  Google Scholar 

  41. Singaram C, Torbey CF, Jacoby RF. Delayed postpolypectomy bleeding. Am J Gastroenterol 1995; 90: 146–147.

    PubMed  CAS  Google Scholar 

  42. Dy NM, Gostout CJ, Balm RK. Bleeding from the endoscopically-identified Dieulafoy lesion of the proximal small intestine and colon. Am J Gastroenterol 1995; 90: 108–111.

    PubMed  CAS  Google Scholar 

  43. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 3–1979. N Engl J Med 1979; 300: 129–135.

    Article  Google Scholar 

  44. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 10–1983. Gastrointestinal bleeding with ocular and cutaneous abnormalities. N Engl J Med 1983; 308: 579–585.

    Article  Google Scholar 

  45. Vase P, Grove O. Gastrointestinal lesions in hereditary hemorrhagic telangiectasia. Gastroenterology 1986; 91: 1079–1083.

    PubMed  CAS  Google Scholar 

  46. Bjarnason I, Hayllar J, MacPherson AJ, Russell AS. Side effects of nonsteroidal antiinflammatory drugs on the small and large intestine in humans. Gastroenterology 1993; 104: 1832–1847.

    PubMed  CAS  Google Scholar 

  47. Wilcox CM, Alexander LN, Cotsonis GA, Clark WS. Nonsteroidal antiinflammatory drugs are associated with both upper and lower gastrointestinal bleeding. Dig Dis Sci 1997; 42: 990–997.

    Article  PubMed  CAS  Google Scholar 

  48. Smalley WE, Griffin MR, Fought RL, Ray WA. Excess costs from gastrointestinal disease associated with nonsteroidal anti-inflammatory drugs. J Gen Intern Med 1996; 11: 461–469.

    Article  PubMed  CAS  Google Scholar 

  49. The role of endoscopy in the patient with lower gastrointestinal bleeding. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1998; 48: 685–688.

    Article  Google Scholar 

  50. Foutch PG, Zimmerman K. Diverticular bleeding and the pigmented protuberance (sentinel clot): clinical implications, histopathological correlation, and results of endoscopic intervention. Am J Gastroenterol 1996; 91: 2589–2593.

    PubMed  CAS  Google Scholar 

  51. Binmoeller KF, Thonke F, Soehendra N. Endoscopic hemoclip treatment for gastrointestinal bleeding. Endoscopy 1993; 25: 167–170.

    Article  PubMed  CAS  Google Scholar 

  52. 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: 78–82.

    Article  PubMed  CAS  Google Scholar 

  53. Santos JC Jr, Aprilli F, Guimaraes AS, Rocha JJ. Angiodysplasia of the colon: endoscopic diagnosis and treatment. Br J Surg 1988; 75: 256–258.

    Article  PubMed  Google Scholar 

  54. Foutch PG. Colonic angiodysplasia. Gastroenterologist 1997; 5: 148–156.

    PubMed  CAS  Google Scholar 

  55. Rosen L, Bub DS, Reed JF 3rd, Nastasee SA. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum 1993; 36: 1126–1131.

    Article  PubMed  CAS  Google Scholar 

  56. Rex DK, Lewis BS, Waye JD. Colonoscopy and endoscopic therapy for delayed post-polypectomy hemorrhage. Gastrointest Endosc 1992; 38: 127–129.

    Article  PubMed  CAS  Google Scholar 

  57. Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1997; 92: 419–424.

    PubMed  CAS  Google Scholar 

  58. Trowers EA, Ganga U, Rizk R, Ojo E, Hodges D. Endoscopic hemorrhoidal ligation: preliminary clinical experience. Gastrointest Endosc 1998; 48: 49–52.

    Article  PubMed  CAS  Google Scholar 

  59. Rosenkrantz H, Bookstein JJ, Rosen RJ, Goff WB 2nd, Healy JF. Postembolic colonic infarction. Radiology 1982; 142: 47–51.

    PubMed  CAS  Google Scholar 

  60. Sherman LM, Shenoy SS, Cerra FB. Selective intra-arterial vasopressin: clinical efficacy and complications. Ann Surg 1979; 189: 298–302.

    Article  PubMed  CAS  Google Scholar 

  61. Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg 1986; 204: 530–536.

    Article  PubMed  CAS  Google Scholar 

  62. Gomes AS, Lois JF, McCoy RD. Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization. AJR Am J Roentgenol 1986; 146: 1031–1037.

    PubMed  CAS  Google Scholar 

  63. McGuire HH Jr. Bleeding colonic diverticula. A reappraisal of natural history and management. Ann Surg 1994; 220: 653–656.

    Article  PubMed  Google Scholar 

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Authors
  1. Russell F. Jacoby MD
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Editors and Affiliations

  1. Section of Gastroenterology, University of Chicago Hospitals, Chicago, IL, USA

    Karen E. Kim MD

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© 2003 Humana Press Inc., Totowa, NJ

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Jacoby, R.F. (2003). Obscure Causes of Acute Lower Gastrointestinal Bleeding. In: Kim, K.E. (eds) Acute Gastrointestinal Bleeding. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-299-9_12

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  • DOI: https://doi.org/10.1007/978-1-59259-299-9_12

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4684-9723-6

  • Online ISBN: 978-1-59259-299-9

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