LOWER G.I. BLEEDING

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LOWER G.I. BLEEDING
DR. JAMAL HAMDI
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Upper G.I. Bleeding True Lower G.I. Bleeding
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Massive G.I. Bleeding

1. Diverticular disease
2. Vascular ectasia

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Causes of bleeding per rectum

• Cancer Polyps
• Common Anorectal diseases
• Ischemic Infectious Colitis
• Inflammatory bowel diseases
• Meckels diverticulum

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Proctoscopy sigmoidscopy
History Examination
No Blood
Lower G.I. Bleeding
Nasogastric aspiration
Laboratory
Blood
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Anorectal Pathology
Proctoscopy Sigmoidscopy
No Anorectal Pathology
RBC Scan
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Positive
Angiography
RBC Scan
Colonoscopy
Negative
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Site localized
Vasopressin infusion
Angiography
Site not localized
Segmental resection
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Observe
Bleeding stop
or
Segmental resection
Vasopressin infusion
Bleeding continue
Segmental resection
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Lesion found
Segmental resection
Colonoscopy
Lesion not found
Total Colectomy ?
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Tagged Red blood cell Scan
30-60 minutes preparation 2 hours
duration Detect gt 0.5 ml/min Useful in
intermittent bleeding
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Sulfur Colloid Scan
20 minutes duration Detect gt 0.1 ml/min Cleared
by Liver and spleen
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Angiography
Detect 0.5 1.0 ml/min Identify exact
vessel May identify lesion Therapeutic a)
Vasopressin b) Embolisation
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Emergency Surgery if

• Patient needed gt 6 units Blood / 24 hours
• Continue bleeding after vasopressin or
• embolisation

Thank you