Acute Lower Gastrointestinal Bleeding: Part I

Abstract

Acute lower gastrointestinal (LGI) bleeding is typically caused by vascular malformations, diverticuli and neoplasia. Although endoscopic evaluation of the colon is relatively standard in stable patients with LGI bleeding, those with significant ongoing hemorrhage are often more difficult to evaluate endoscopically. Other investigative techniques such as nuclear scintigraphy, angiography and surgical exploration have been commonly used in unstable patients with LGI bleeding when the exact site is unknown. These investigative techniques have had variable measures of success. This two-part review evaluates the literature in an attempt to review the optimal investigative approach in patients with LGI hemorrhage, in particular patients who have had significant and ongoing bleeding. Part 1 of this article concentrates on the etiology of LGI hemorrhage, followed in a subsequent article by diagnostic and management strategies. Following the review, a consensus update will be included with guidelines for clinical use.

Severe acute lower gastrointestinal bleeding: risk factors for morbidity and mortality

“…If it is not controlled, endoscopy [6,14,15,[24][25][26] and interventional radiology [6,[27][28][29] can currently be used with good results. However, more experience is needed to establish the value of both techniques.…”

Kolorektale Blutung – Differentialdiagnostik und Therapie

“…Die häufigste Blutungsquelle sind Divertikel (40%). Bei der differentialdiagnostischen Abklärung müssen arteriovenöse Malformationen (10%), Kolitiden unterschiedlicher Genese (10%), Neoplasien (10%), anorektale Erkrankungen (10%) sowie chronisch entzündliche Darmerkrankungen (5%) in Erwägung gezogen werden, wobei die Häufigkei-ten der verschiedenen Blutungsursachen mit dem Alter variieren [3,4]. Im jüngeren Alter sind akute untere gastrointestinale Blutungen selten.…”

Akute untere Gastrointestinalblutung

“…Entscheidend ist ein erfahrenes,jederzeit rufbereites endoskopisches Team,das mit allen diagnostischen und therapeutischen Interventionen vertraut ist.In ca.80% der Fälle kann bei schwerer Hä-matochezie die Blutungsquelle erfolgreich koloskopisch identifiziert werden[10,30]. In etwa 40% liegen Veränderungen vor, bei denen die endoskopische Intervention Blutungsstillstand erzielen kann[6].…”