Bleeding from the lower digestive tract

It is one that occurs at a point distal to the ligament of treitz and may include tarry stools (melena) or expulsion of red blood (hematochezia).

Causes

The causes vary greatly according to age groups. By the anatomical site can be:

  • Jejunum and ileum: Meckel's diverticulum, intussusception and regional enteritis.
  • Colon: carcinoma, massive diverticulosis, vascular ectasias (right half of the colon), colitis, and polyps.
  • Rectum and anus: fresh blood with feces, hemorrhoids, cracks and proctitis.

Diagnosis

It includes exact history, family pictures (polyposis) and drugs. The operator should look for mucosal lesions that cause Osler-Weber-Rendu syndrome or Peutz-Jeghers syndrome. Abdominal examination detects masses. Digital rectal examination is needed to look for masses and lesions. Proctosigmoidoscopy needs to be done early. Colonoscopy is done if the bleeding is not massive. Studies with radioactive isotopes are undertaken in slow bleeding (1 ml/minute) and angiography (which is more accurate) in rapid bleeding (2 to 3 ml/minute). Barium studies should be carried out in non-acute haemorrhages (carcinomas, polyps).