Lower Gastrointestinal Hemorrhage
Lower gastrointestinal bleeding refers to bleeding from a source distal to the ligament of Treitz. Presentation ranges from occult bleeding with anemia to frank hemorrhage with cardiovascular collapse. Management hinges on volume resuscitation and restoration of hemodynamic stability, followed by a search for the source of bleeding. Investigative measures include colonoscopy, nuclear scintigraphy, CT angiography, and mesenteric angiography. If an active source of bleeding is identified, therapeutic angiography and embolization should be attempted. Active bleeding identified during colonoscopy should be controlled endoscopically. Surgery is reserved for patients with ongoing hemorrhage and hemodynamic instability or for those who fail nonsurgical management.