Lower Gastrointestinal Hemorrhage

Abstract

Lower gastrointestinal hemorrhage refers to a spectrum of intestinal bleeding that arises distal to the ligament of Treitz. It may range from occult bleeding or occasional spotting of blood to massive lower intestinal hemorrhage. True massive intestinal hemorrhage typically involves hemodynamic compromise or acute symptomatic anemia. Multiple sources define massive bleeding to include patients with an acute drop in their hematocrit to less than 30%, patients with transfusion requirements (up to 3–5 units of blood/blood products), or orthostasis requiring resuscitation. Melena typically suggests bleeding from a more proximal source in the colon or small intestine. Hematochezia suggests left colonic, rectal, or anal sources. Overall, it is believed that upper sources may present with lower gastrointestinal bleeding symptoms in 10–15% of cases. Most often the intestinal bleeding resolves spontaneously often while undergoing supportive hospital care. In clinical scenarios in which the bleeding resolved spontaneously, the diagnostic evaluation may only unmask potential sources. Without associated attached clot or active bleeding, the true site of hemorrhage may never be elucidated. Current treatment regimens incorporate remediating the impact of long-term anticoagulants and antiplatelet agents for underlying cardiovascular conditions. Hemorrhage in these patients proves more life-threatening.