Lower Intestinal Hemorrhage

Ellis, David; Reinus, John F.

doi:10.1016/s0749-0704(18)30072-1

Cited by 16 publications

(5 citation statements)

References 49 publications

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“…Hemorrhoidal disease is the most prevalent anorectal disorder and is a major cause of acute or recurrent rectal bleeding; 10–13 however detection of hemorrhoids does not rule out the presence of synchronous lesions accounting for bleeding 14–16 . Furthermore, many studies have demonstrated the poor ability of physicians to distinguish which patients with rectal bleeding have colonic neoplasm and which have only benign anal diseases on the basis of history and physical examination 17,18 .…”

Section: Discussionmentioning

confidence: 99%

Videoanoscopy: Useful technique in the evaluation of hemorrhoids

Harish

Harikumar

Sunilkumar

et al. 2008

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 99%

Videoanoscopy: Useful technique in the evaluation of hemorrhoids

Harish

Harikumar

Sunilkumar

et al. 2008

J of Gastro and Hepatol

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“…They are degenerative lesions believed to originate from chronic, partial obstruction of submucosal veins with subsequent capillary dilation and damage to capillary sphincters, ultimately resulting in incompetence and finally arteriovenous connections (17,61). This theory fits clinically because most angiodysplastic lesions are found in the cecum, which, due to its larger relative diameter, must exhibit greater wall tension (Laplace's Law) (3,(62)(63)(64). Approximately 70% of symptomatic angiodysplastic lesions occur in the right colon (33% in the cecum, 39% in the hepatic flexure or ascending colon), with the sigmoid (22%) and transverse colon (6%) being affected less frequently (33,65).…”

Section: Specific Causes Of Lgi Bleeding Colonic Diverticulosismentioning

confidence: 99%

“…Rossini et al (28) reported that 32% of patients with massive colonic bleeding had ulcerated carcinomas or polyps, while Jensen and Machicado (33) reported it as a cause in only 11% of patients. The true incidence is likely somewhere in between (4,7,16,20,25,27,63,77). Polyps and small cancers are amenable to endoscopic therapy, but most cancers require surgical intervention.…”

Section: Specific Causes Of Lgi Bleeding Colonic Diverticulosismentioning

confidence: 99%

“…Specific diagnosis and localization are often difficult because of the small bowel length, redundancy, tortuosity and general inaccessibility. Angiodysplasia accounts for 70% to 80% of small bowel hemorrhage with other diagnoses, including jejunoileal diverticula (105,107), Meckel's diverticulum (63), neoplasia (benign and malignant), enteritis and aortoenteric fistula (56,89,105,108).…”

Section: Specific Causes Of Lgi Bleeding Colonic Diverticulosismentioning

confidence: 99%

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Acute Lower Gastrointestinal Bleeding: Part I

Enns

2001

Canadian Journal of Gastroenterology and Hepatology

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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.

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“…Estimates are that as many as 6% of patients with either Crohn's disease or ulcerative colitis experience severe LGB. In Crohn's disease, the risk of severe bleeding appears to be higher due to transmural inflammation and deep ulceration [31]. It has been reported that some 50% of patients with LGB caused by IBD stop bleeding spontaneously but 35% rebleed.…”

Section: Inflammatory Bowel Diseasementioning

confidence: 99%

Genesis and pathophysiology of lower gastrointestinal bleeding

Imdahl

2001

Langenbeck's Archives of Surgery

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The incidence of lower gastrointestinal bleeding (LGB) is estimated to be 20-30 per 100,000 of the adult population at risk, which is clearly correlated with increasing age. The problem of LGB is identification of the bleeding source. LGB stops spontaneously in 80% of cases, but 10% of bleeding sources cannot be identified, and rebleeding occurs in 25%. The quality of LGB--hematochezia, melena, or occult bleeding--may point to the region of the bleeding source, as patient age is correlated with specific pathologies. In many patients, LGB is a leading symptom of a chronic disorder. Most acute peranal bleeding arises from the colon (80%) with colonic diverticula and angiodysplastic lesions as the most frequent reasons. In 5% of cases, LGB is caused by disorders of the small bowel, in most cases due to small-bowel tumors or to Meckel's diverticulum in younger patients. In 15-20%, acute peranal bleeding is caused by lesions in the upper gastrointestinal tract. The intensity of LGB determines the urgency of identification of the bleeding source; however, chronic occult blood loss superimposed by melena may place the patient at risk as early as a patient with hematochezia. Therefore, prompt resuscitation is required in many LGB patients before diagnostic procedures are initiated.

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Lower Intestinal Hemorrhage

Cited by 16 publications

References 49 publications

Videoanoscopy: Useful technique in the evaluation of hemorrhoids

Videoanoscopy: Useful technique in the evaluation of hemorrhoids

Acute Lower Gastrointestinal Bleeding: Part I

Genesis and pathophysiology of lower gastrointestinal bleeding

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