Skip to main content
Top
Published in: Diseases of the Colon & Rectum 11/2005

01-11-2005 | Current Status

The Management of Lower Gastrointestinal Hemorrhage

Authors: Rebecca E. Hoedema, M.D., Martin A. Luchtefeld, M.D.

Published in: Diseases of the Colon & Rectum | Issue 11/2005

Login to get access

PURPOSE

Gastrointestinal hemorrhage is a common clinical problem, which accounts for approximately 1 to 2 percent of acute hospital admissions. The colon is responsible for approximately 87 to 95 percent of all cases of lower gastrointestinal bleeding, with the remaining cases arising in the small bowel. The etiology, diagnostic evaluation, management, and treatment options available for lower gastrointestinal hemorrhage were reviewed.

METHODS

A review of lower gastrointestinal bleeding was performed, which discussed the most common etiologies with a few rare and unusual causes. The current literature about different diagnostic techniques, management problems, and therapeutic options was reviewed. Current management strategies and treatment options for the many causes of lower gastrointestinal bleeding will be reviewed.

RESULTS

A review of the different causes of lower gastrointestinal hemorrhage and available diagnostic studies was performed. Management strategies based on the etiology of the bleeding and results of the diagnostic studies were discussed. An algorithm was provided to develop a diagnostic and therapeutic treatment strategy for lower gastrointestinal hemorrhage.

CONCLUSIONS

Lower gastrointestinal hemorrhage can be a difficult and frustrating problem to both the clinician and the patient. Knowledge of the available diagnostic tests to help identify the source of bleeding is essential to the practicing clinician. Once the source is identified, management strategies and available treatment options need to be specific for each individual case. This review will aid the practicing physician in developing an algorithm for lower gastrointestinal hemorrhage.
Literature
1.
go back to reference Farrands, PA, Taylor, I 1987Management of acute lower gastrointestinal hemorrhage in a surgical unit over a four-year periodJ R Soc Med807982PubMed Farrands, PA, Taylor, I 1987Management of acute lower gastrointestinal hemorrhage in a surgical unit over a four-year periodJ R Soc Med807982PubMed
2.
go back to reference Leitman, IM, Paul, DE, Shires, GT 1989Evaluation and management of massive lower gastrointestinal hemorrhageAnn Surg20917580PubMed Leitman, IM, Paul, DE, Shires, GT 1989Evaluation and management of massive lower gastrointestinal hemorrhageAnn Surg20917580PubMed
3.
go back to reference Wagner, HE, Stain, SC, Gilg, M, Gertsch, P 1992Systematic assessment of massive bleeding of the lower part of the gastrointestinal tractSurg Gynecol Obstet1754459PubMed Wagner, HE, Stain, SC, Gilg, M, Gertsch, P 1992Systematic assessment of massive bleeding of the lower part of the gastrointestinal tractSurg Gynecol Obstet1754459PubMed
4.
go back to reference Potter, GD, Sellin, JH 1988Lower gastrointestinal bleedingGastroenterol Clin North Am1734155PubMed Potter, GD, Sellin, JH 1988Lower gastrointestinal bleedingGastroenterol Clin North Am1734155PubMed
5.
go back to reference Caos, A, Benner, KG, Manier, J, et al. 1986Colonoscopy after Golytely preparation in acute rectal bleedingJ Clin Gastroenterol8469PubMed Caos, A, Benner, KG, Manier, J,  et al. 1986Colonoscopy after Golytely preparation in acute rectal bleedingJ Clin Gastroenterol8469PubMed
6.
go back to reference Jensen, DM, Machicado, GA 1988Diagnosis and treatment of severe hematochezia: the role of urgent colonoscopy after purgeGastroenterology95156974PubMed Jensen, DM, Machicado, GA 1988Diagnosis and treatment of severe hematochezia: the role of urgent colonoscopy after purgeGastroenterology95156974PubMed
7.
go back to reference Breen, E, Murray, JJ 1997Pathophysiology and natural history of lower gastrointestinal bleedingSemin Colon Rectal Surg812838 Breen, E, Murray, JJ 1997Pathophysiology and natural history of lower gastrointestinal bleedingSemin Colon Rectal Surg812838
8.
go back to reference Boley, SJ, Sammartano, R, Adams, A, DiBiase, A, Kleinhaus, S, Sprayregen, S 1997On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of agingGastroenterology7265060 Boley, SJ, Sammartano, R, Adams, A, DiBiase, A, Kleinhaus, S, Sprayregen, S 1997On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of agingGastroenterology7265060
9.
go back to reference King, RM, Pluth, JR, Giuliani, ER 1987The association of unexplained gastrointestinal bleeding with calcific aortic stenosisAnn Thorac Surg445146PubMed King, RM, Pluth, JR, Giuliani, ER 1987The association of unexplained gastrointestinal bleeding with calcific aortic stenosisAnn Thorac Surg445146PubMed
10.
go back to reference Williams, JC,Jr 1961Aortic stenosis and unexplained gastrointestinal bleedingArch Intern Med10885963PubMed Williams, JC,Jr 1961Aortic stenosis and unexplained gastrointestinal bleedingArch Intern Med10885963PubMed
11.
go back to reference Imperiale, TF, Ransohoff, DF 1988Aortic stenosis, idiopathic gastrointestinal bleeding and angiodysplasia: is there an association?Gastroenterology9516706PubMed Imperiale, TF, Ransohoff, DF 1988Aortic stenosis, idiopathic gastrointestinal bleeding and angiodysplasia: is there an association?Gastroenterology9516706PubMed
12.
go back to reference Robert, JR, Sachar, DB, Greenstein, AJ 1991Severe gastrointestinal hemorrhage in Crohn’s diseaseAnn Surg21320711PubMed Robert, JR, Sachar, DB, Greenstein, AJ 1991Severe gastrointestinal hemorrhage in Crohn’s diseaseAnn Surg21320711PubMed
13.
go back to reference Robert, JR, Sachar, DB, Aufses, AH,Jr, Greenstein, AJ 1990Management of severe hemorrhage in ulcerative colitisAm J Surg1595505PubMed Robert, JR, Sachar, DB, Aufses, AH,Jr, Greenstein, AJ 1990Management of severe hemorrhage in ulcerative colitisAm J Surg1595505PubMed
14.
go back to reference Chowla, Y, Dilawari, DB 1991Anorectal varices—their frequency in cirrhotic and non-cirrhotic portal hypertensionGut3230111 Chowla, Y, Dilawari, DB 1991Anorectal varices—their frequency in cirrhotic and non-cirrhotic portal hypertensionGut3230111
15.
go back to reference Rabinovitz, M, Schade, RR, Dindzaus, VJ, Belle, SH, Thiel, DH, Gavaler, JS 1990Colonic disease in cirrhosis: an endoscopic evaluation in 412 patientsGastroenterology991959PubMed Rabinovitz, M, Schade, RR, Dindzaus, VJ, Belle, SH, Thiel, DH, Gavaler, JS 1990Colonic disease in cirrhosis: an endoscopic evaluation in 412 patientsGastroenterology991959PubMed
16.
go back to reference Abdulian, JD, Santoro, MJ, Chen, YK, Collen, MJ 1993Dieulafoy-like lesion of the rectum presenting with exsanguinating hemorrhageAm J Gastroenterol88193941PubMed Abdulian, JD, Santoro, MJ, Chen, YK, Collen, MJ 1993Dieulafoy-like lesion of the rectum presenting with exsanguinating hemorrhageAm J Gastroenterol88193941PubMed
17.
go back to reference Peter, P, Deyhle, P, Brandli, H, et al. 1974Endoscopic diagnosis of acute perianal hemorrhageEndoscopy622932 Peter, P, Deyhle, P, Brandli, H,  et al. 1974Endoscopic diagnosis of acute perianal hemorrhageEndoscopy622932
18.
go back to reference Wright, HK 1980Massive colonic hemorrhageSurg Clin North Am601297304PubMed Wright, HK 1980Massive colonic hemorrhageSurg Clin North Am601297304PubMed
19.
go back to reference DeMarkles, MP, Murphy, JR 1993Acute lower gastrointestinal bleedingMed Clin North Am77108599PubMed DeMarkles, MP, Murphy, JR 1993Acute lower gastrointestinal bleedingMed Clin North Am77108599PubMed
20.
go back to reference Rossini, FP, Ferrari, A, Spandre, M, et al. 1989Emergency colonoscopyWorld J Surg131902PubMedCrossRef Rossini, FP, Ferrari, A, Spandre, M,  et al. 1989Emergency colonoscopyWorld J Surg131902PubMedCrossRef
21.
go back to reference Johnston, JH, Sones, JQ, Long, BW, Posey, EL 1985Comparison of heater probe and YAG laser in endoscopic treatment of major bleeding from peptic ulcersGastrointest Endosc3117580PubMed Johnston, JH, Sones, JQ, Long, BW, Posey, EL 1985Comparison of heater probe and YAG laser in endoscopic treatment of major bleeding from peptic ulcersGastrointest Endosc3117580PubMed
22.
go back to reference Pardoll, PM, Neubrand, S 1989Injection control of colonic hemorrhage with hypertonic saline-epinephrine solution [abstract]Am J Gastroenterol841193 Pardoll, PM, Neubrand, S 1989Injection control of colonic hemorrhage with hypertonic saline-epinephrine solution [abstract]Am J Gastroenterol841193
23.
go back to reference Bertoni, G, Conigliaro, R, Ricci, E, Mortilla, MG, Bedogni, G, Fornaciari, G 1990Endoscopic injection hemostasis of colonic diverticular bleeding: a case reportEndoscopy221545PubMed Bertoni, G, Conigliaro, R, Ricci, E, Mortilla, MG, Bedogni, G, Fornaciari, G 1990Endoscopic injection hemostasis of colonic diverticular bleeding: a case reportEndoscopy221545PubMed
24.
go back to reference Kim, YI, Marcon, NE 1993Injection therapy for colonic diverticular bleeding: a case studyJ Clin Gastroenterol17468PubMed Kim, YI, Marcon, NE 1993Injection therapy for colonic diverticular bleeding: a case studyJ Clin Gastroenterol17468PubMed
25.
go back to reference Andress, HJ, Mewes, A, Lange, V 1993Endoscopic hemostasis of a bleeding diverticulum of the sigma with fibrin sealantEndoscopy25193PubMedCrossRef Andress, HJ, Mewes, A, Lange, V 1993Endoscopic hemostasis of a bleeding diverticulum of the sigma with fibrin sealantEndoscopy25193PubMedCrossRef
26.
go back to reference Savides, TJ, Jensen, DM 1994Colonoscopic hemostasis for recurrent diverticular hemorrhage associated with a visible vessel: a report of three casesGastrointest Endosc40703PubMedCrossRef Savides, TJ, Jensen, DM 1994Colonoscopic hemostasis for recurrent diverticular hemorrhage associated with a visible vessel: a report of three casesGastrointest Endosc40703PubMedCrossRef
27.
go back to reference Ramirez, FC, Johnson, DA, Zierer, ST, et al. 1996Successful endoscopic hemostasis of bleeding colonic diverticula with epinephrine injectionGastrointest Endosc4316770PubMedCrossRef Ramirez, FC, Johnson, DA, Zierer, ST,  et al. 1996Successful endoscopic hemostasis of bleeding colonic diverticula with epinephrine injectionGastrointest Endosc4316770PubMedCrossRef
28.
go back to reference Foutch, PG, Zimmerman, K 1996Diverticular bleeding and the pigmented protuberance (sentinel clot); clinical implications, histopathological correlation, and results of endoscopic interventionAm J Gastroenterol91258993PubMed Foutch, PG, Zimmerman, K 1996Diverticular bleeding and the pigmented protuberance (sentinel clot); clinical implications, histopathological correlation, and results of endoscopic interventionAm J Gastroenterol91258993PubMed
29.
go back to reference Hokama, A, Uehara, T, Nakayoshi, T, et al. 1997Utility of endoscopic hemoclipping for colonic diverticular bleedingAm J Gastroenterol925436PubMed Hokama, A, Uehara, T, Nakayoshi, T,  et al. 1997Utility of endoscopic hemoclipping for colonic diverticular bleedingAm J Gastroenterol925436PubMed
30.
go back to reference Prakash, C, Chokshi, H, Walden, DT, Aliperti, G 1999Endoscopic hemostasis in acute diverticular bleedingEndoscopy314603PubMedCrossRef Prakash, C, Chokshi, H, Walden, DT, Aliperti, G 1999Endoscopic hemostasis in acute diverticular bleedingEndoscopy314603PubMedCrossRef
31.
go back to reference Jensen, DM, Machicado, GA, Jutabha, R, Kovacs, TO 2000Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhageN Engl J Med3427882PubMedCrossRef Jensen, DM, Machicado, GA, Jutabha, R, Kovacs, TO 2000Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhageN Engl J Med3427882PubMedCrossRef
32.
go back to reference Bloomfeld, RS, Smith, TP, Schneider, AM, Rockey, DC 2000Provocative angiography in patients with gastrointestinal hemorrhage of obscure originAm J Gastroenterol95280712PubMed Bloomfeld, RS, Smith, TP, Schneider, AM, Rockey, DC 2000Provocative angiography in patients with gastrointestinal hemorrhage of obscure originAm J Gastroenterol95280712PubMed
33.
go back to reference Bloomfeld, RS, Rockey, DC, Shetzline, MA 2001Endoscopic therapy of acute diverticular hemorrhageAm J Gastroenterol96236772PubMedCrossRef Bloomfeld, RS, Rockey, DC, Shetzline, MA 2001Endoscopic therapy of acute diverticular hemorrhageAm J Gastroenterol96236772PubMedCrossRef
34.
go back to reference Alavi, A, Dann, RW, Baum, S, Biery, DN 1977Scintigraphic detection of acute gastrointestinal bleedingRadiology1247536PubMed Alavi, A, Dann, RW, Baum, S, Biery, DN 1977Scintigraphic detection of acute gastrointestinal bleedingRadiology1247536PubMed
35.
go back to reference Gupta, N, Longo, WE, Vernava, AM,III 1995Angiodysplasia of the lower gastrointestinal tract: an entity readily diagnosed by colonoscopy and primarily managed nonoperativelyDis Colon Rectum3897982PubMedCrossRef Gupta, N, Longo, WE, Vernava, AM,III 1995Angiodysplasia of the lower gastrointestinal tract: an entity readily diagnosed by colonoscopy and primarily managed nonoperativelyDis Colon Rectum3897982PubMedCrossRef
36.
go back to reference McKusick, KA, Froelich, J, Callahan, RJ, Winzelberg, GG, Strauss, HW 198199mTc red blood cells for detection of gastrointestinal bleeding: experience with 80 patientsAJR Am J Roentgenol13711138PubMed McKusick, KA, Froelich, J, Callahan, RJ, Winzelberg, GG, Strauss, HW 198199mTc red blood cells for detection of gastrointestinal bleeding: experience with 80 patientsAJR Am J Roentgenol13711138PubMed
37.
go back to reference Kester, RR, Welch, JP, Sziklas, JP 1984The 99mTc-Iabeled RBC scan. a diagnostic method for lower gastrointestinal bleedingDis Colon Rectum274752PubMed Kester, RR, Welch, JP, Sziklas, JP 1984The 99mTc-Iabeled RBC scan. a diagnostic method for lower gastrointestinal bleedingDis Colon Rectum274752PubMed
38.
go back to reference Bentley, DE, Richardson, JD 1991The role of tagged red blood cell imaging in the localization of gastrointestinal bleedingArch Surg268214 Bentley, DE, Richardson, JD 1991The role of tagged red blood cell imaging in the localization of gastrointestinal bleedingArch Surg268214
39.
go back to reference Winzelberg, GG, McKusick, KA, Froelich, JW, Callahan, RJ, Strauss, HW 1982Detection of gastrointestinal bleeding with 99mTc labeled red blood cellsSemin Nucl Med1213946PubMed Winzelberg, GG, McKusick, KA, Froelich, JW, Callahan, RJ, Strauss, HW 1982Detection of gastrointestinal bleeding with 99mTc labeled red blood cellsSemin Nucl Med1213946PubMed
40.
go back to reference Bunker, TG, Lull, RJ, Tanasecu, DE, et al. 1984Scintigraphy of gastrointestinal hemorrhage: superiority of 99mTc red blood cells over 99mTc sulfur colloidAJR Am J Roentgenol1435438PubMed Bunker, TG, Lull, RJ, Tanasecu, DE,  et al. 1984Scintigraphy of gastrointestinal hemorrhage: superiority of 99mTc red blood cells over 99mTc sulfur colloidAJR Am J Roentgenol1435438PubMed
41.
go back to reference Szasz, IJ, Morrison, RT, Lyster, DM 1985Technetium 99m-labeled red blood cell scintigraphy to diagnose occult gastrointestinal bleedingCan J Surg285124PubMed Szasz, IJ, Morrison, RT, Lyster, DM 1985Technetium 99m-labeled red blood cell scintigraphy to diagnose occult gastrointestinal bleedingCan J Surg285124PubMed
42.
go back to reference Thorne, DA, Datz, FL, Remley, K, Christian, PE 1987Bleeding rates necessary for detecting acute gastrointestinal bleeding with technetium- 99m-labeled red blood cells in an experimental modelJ Nucl Med2851420PubMed Thorne, DA, Datz, FL, Remley, K, Christian, PE 1987Bleeding rates necessary for detecting acute gastrointestinal bleeding with technetium- 99m-labeled red blood cells in an experimental modelJ Nucl Med2851420PubMed
43.
go back to reference Voeller, GR, Bunch, G, Britt, LG 1991Use of technetium-labeled red blood cell scintigraphy in the detection and management of gastrointestinal hemorrhageSurgery110799804PubMed Voeller, GR, Bunch, G, Britt, LG 1991Use of technetium-labeled red blood cell scintigraphy in the detection and management of gastrointestinal hemorrhageSurgery110799804PubMed
44.
go back to reference Nusbaum, M, Baum, S 1963Radiographic demonstration of unknown sites of gastrointestinal bleedingSurg Forum1437475PubMed Nusbaum, M, Baum, S 1963Radiographic demonstration of unknown sites of gastrointestinal bleedingSurg Forum1437475PubMed
45.
go back to reference Bearne, P, Persad, R, Wilson, N, Flanagan, J, Williams, T 199299m-Technetium-labelled red blood cell scintigraphy as an alternative to angiography in the investigation of gastrointestinal bleeding: clinical experience in a district general hospitalAnn R Coll Surg Engl741929 Bearne, P, Persad, R, Wilson, N, Flanagan, J, Williams, T 199299m-Technetium-labelled red blood cell scintigraphy as an alternative to angiography in the investigation of gastrointestinal bleeding: clinical experience in a district general hospitalAnn R Coll Surg Engl741929
46.
go back to reference Hunter, JM, Pezim, MR 1990Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleedingAm J Surg595046 Hunter, JM, Pezim, MR 1990Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleedingAm J Surg595046
47.
go back to reference Miller, GA, Borten, MM 1991Primary carcinoid tumour of the ileum associated with massive gastrointestinal haemorrhageANZ J Surg616456 Miller, GA, Borten, MM 1991Primary carcinoid tumour of the ileum associated with massive gastrointestinal haemorrhageANZ J Surg616456
48.
go back to reference Nicholson, ML, Neoptolemos, JP, Sharp, JF, Watkin, EM, Fossard, DP 1989Localization of lower gastrointestinal bleeding using in vivo technetium-99m-labeled red blood cell scintigraphyBr J Surg7635861PubMed Nicholson, ML, Neoptolemos, JP, Sharp, JF, Watkin, EM, Fossard, DP 1989Localization of lower gastrointestinal bleeding using in vivo technetium-99m-labeled red blood cell scintigraphyBr J Surg7635861PubMed
49.
go back to reference Suzman, MS, Talmor, M, Jennis, R, Brinkert, B, Barie, PS 1996Accurate localization and surgical management of active lower gastrointestinal hemorrhage with technetium-labeled erythrocyte scintigraphyAnn Surg2242936PubMedCrossRef Suzman, MS, Talmor, M, Jennis, R, Brinkert, B, Barie, PS 1996Accurate localization and surgical management of active lower gastrointestinal hemorrhage with technetium-labeled erythrocyte scintigraphyAnn Surg2242936PubMedCrossRef
50.
go back to reference Ryan, P, Styles, CB, Chmiel, R 1992Identification of the site of severe colon bleeding by technetium-labeled red-cell scanDis Colon Rectum3521922PubMedCrossRef Ryan, P, Styles, CB, Chmiel, R 1992Identification of the site of severe colon bleeding by technetium-labeled red-cell scanDis Colon Rectum3521922PubMedCrossRef
51.
go back to reference Whitaker, SC, Perkins, AC, Wastie, ML 1993The value of scintigraphic studies in the assessment of patients with acute or chronic gastrointestinal haemorrhageNucl Med Commun144118PubMed Whitaker, SC, Perkins, AC, Wastie, ML 1993The value of scintigraphic studies in the assessment of patients with acute or chronic gastrointestinal haemorrhageNucl Med Commun144118PubMed
52.
go back to reference Casarella, WJ, Galloway, SJ, Taxin, RN, Follett, DA, Pollack, EJ, Seaman, WB 1974Lower gastrointestinal tract hemorrhage: new concepts based on arteriographyAJR Am J Roentgenol12135768 Casarella, WJ, Galloway, SJ, Taxin, RN, Follett, DA, Pollack, EJ, Seaman, WB 1974Lower gastrointestinal tract hemorrhage: new concepts based on arteriographyAJR Am J Roentgenol12135768
53.
go back to reference Nath, RL, Sequeira, JC, Weitzman, AF, Birkett, DH, Wil-liams, LF,Jr 1981Lower gastrointestinal bleeding: diagnostic approach and management conclusionsAm J Surg14147881PubMedCrossRef Nath, RL, Sequeira, JC, Weitzman, AF, Birkett, DH, Wil-liams, LF,Jr 1981Lower gastrointestinal bleeding: diagnostic approach and management conclusionsAm J Surg14147881PubMedCrossRef
54.
go back to reference Uden, P, Jiborn, H, Jonsson, K 1986Influence of selective mesenteric arteriography on the outcome of emergency surgery for massive, lower gastrointestinal hemorrhage: a 15-year experienceDis Colon Rectum295616PubMed Uden, P, Jiborn, H, Jonsson, K 1986Influence of selective mesenteric arteriography on the outcome of emergency surgery for massive, lower gastrointestinal hemorrhage: a 15-year experienceDis Colon Rectum295616PubMed
55.
go back to reference Welch, CE, Athanasoulus, CA, Galdabini, JJ 1978Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular diseaseWorld J Surg27383PubMedCrossRef Welch, CE, Athanasoulus, CA, Galdabini, JJ 1978Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular diseaseWorld J Surg27383PubMedCrossRef
56.
go back to reference Colacchio, TA, Forde, KA, Patsos, TJ, Nunez, D 1982Impact of modern diagnostic methods on the management of rectal bleedingAm J Surg4360710 Colacchio, TA, Forde, KA, Patsos, TJ, Nunez, D 1982Impact of modern diagnostic methods on the management of rectal bleedingAm J Surg4360710
57.
go back to reference Britt, LG, Warren, L, Moore, OF 1983Selective management of lower gastrointestinal bleedingAm Surg491215PubMed Britt, LG, Warren, L, Moore, OF 1983Selective management of lower gastrointestinal bleedingAm Surg491215PubMed
58.
go back to reference Browder, W, Cerise, EJ, Litwin, MS 1986Impact of emergency angiography in massive lower gastrointestinal bleedingAnn Surg2045306PubMed Browder, W, Cerise, EJ, Litwin, MS 1986Impact of emergency angiography in massive lower gastrointestinal bleedingAnn Surg2045306PubMed
59.
go back to reference Koval, G, Benner, KG, Rosch, J, Kozak, BE 1987Aggressive angiographic diagnosis in acute lower gastrointestinal hemorrhageDig Dis Sci3224853PubMedCrossRef Koval, G, Benner, KG, Rosch, J, Kozak, BE 1987Aggressive angiographic diagnosis in acute lower gastrointestinal hemorrhageDig Dis Sci3224853PubMedCrossRef
60.
go back to reference Baum, S, Athanasoulis, CA, Waltman, AC, et al. 1977Angiodysplasia of the right colon: a cause of gastrointestinal bleedingAJR Am J Roentgenol12978994PubMed Baum, S, Athanasoulis, CA, Waltman, AC,  et al. 1977Angiodysplasia of the right colon: a cause of gastrointestinal bleedingAJR Am J Roentgenol12978994PubMed
61.
go back to reference Malden, ES, Hicks, ME, Royal, HD, Aliperti, G, Allen, BT, Picus, D 1998Recurrent gastrointestinal bleeding: use of thrombolysis with anticoagulation in diagnosisRadiology20714751PubMed Malden, ES, Hicks, ME, Royal, HD, Aliperti, G, Allen, BT, Picus, D 1998Recurrent gastrointestinal bleeding: use of thrombolysis with anticoagulation in diagnosisRadiology20714751PubMed
62.
go back to reference Mernagh, JR, O’Donovan, N, Somers, S, Gill, G, Sridhar, S 2001Use of heparin in the investigation of obscure gastrointestinal bleedingCan Assoc Radiol J522325PubMed Mernagh, JR, O’Donovan, N, Somers, S, Gill, G, Sridhar, S 2001Use of heparin in the investigation of obscure gastrointestinal bleedingCan Assoc Radiol J522325PubMed
63.
go back to reference Cappell, MS, Friedel, D 2002The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy, and complicationsMed Clin North Am86125388PubMed Cappell, MS, Friedel, D 2002The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy, and complicationsMed Clin North Am86125388PubMed
64.
go back to reference Mylonaki, M, Fritscher-Ravens, A, Swain, P 2003Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleedingGut5211226PubMedCrossRef Mylonaki, M, Fritscher-Ravens, A, Swain, P 2003Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleedingGut5211226PubMedCrossRef
65.
go back to reference Hartmann, D, Schilling, D, Bolz, G, Riemann, JF 2003Capsule endoscopy versus push enteroscopy in patients with occult gastrointestinal bleedingZ Gastroenterol4137782PubMedCrossRef Hartmann, D, Schilling, D, Bolz, G, Riemann, JF 2003Capsule endoscopy versus push enteroscopy in patients with occult gastrointestinal bleedingZ Gastroenterol4137782PubMedCrossRef
66.
go back to reference Costamagna, G, Shah, SK, Riccioni, ME, et al. 2002A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel diseaseGastroenterology1239991005PubMedCrossRef Costamagna, G, Shah, SK, Riccioni, ME,  et al. 2002A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel diseaseGastroenterology1239991005PubMedCrossRef
67.
go back to reference Liangpunsakul, S, Chadalawada, V, Rex, DK, Maglinte, D, Lappas, J 2003Wireless capsule endoscopy detects small bowel ulcers in patients with normal results from state of the art enteroclysisAm J Gastroenterol9812958PubMed Liangpunsakul, S, Chadalawada, V, Rex, DK, Maglinte, D, Lappas, J 2003Wireless capsule endoscopy detects small bowel ulcers in patients with normal results from state of the art enteroclysisAm J Gastroenterol9812958PubMed
68.
go back to reference Ernst, O, Bulois, P, Saint-Drenant, S, Leroy, C, Paris, JC, Sergent, G 2003Helical CT in acute lower gastrointestinal bleedingEur Radiol131147PubMed Ernst, O, Bulois, P, Saint-Drenant, S, Leroy, C, Paris, JC, Sergent, G 2003Helical CT in acute lower gastrointestinal bleedingEur Radiol131147PubMed
69.
go back to reference Yamaguchi, T, Yoshikawa, K 2003Enhanced CT for initial localization of active lower gastrointestinal bleedingAbdom Imaging286346PubMed Yamaguchi, T, Yoshikawa, K 2003Enhanced CT for initial localization of active lower gastrointestinal bleedingAbdom Imaging286346PubMed
70.
go back to reference Ettorre, GC, Francioso, G, Garribba, AP, Fracella, MR, Greco, A, Farchi, G 1997Helical CT angiography in gastrointestinal bleeding of obscure originAJR Am J Roentgenol16872731PubMed Ettorre, GC, Francioso, G, Garribba, AP, Fracella, MR, Greco, A, Farchi, G 1997Helical CT angiography in gastrointestinal bleeding of obscure originAJR Am J Roentgenol16872731PubMed
71.
go back to reference Kovacs, TO, Jensen, DM 2002Recent advances in the endoscopic diagnosis and therapy of upper gastrointestinal, small intestinal, and colonic bleedingMed Clin North Am86131956PubMedCrossRef Kovacs, TO, Jensen, DM 2002Recent advances in the endoscopic diagnosis and therapy of upper gastrointestinal, small intestinal, and colonic bleedingMed Clin North Am86131956PubMedCrossRef
72.
go back to reference Vernava, AM, Moore, BA, Longo, WE, Johnson, FE 1997Lower gastrointestinal bleedingDis Colon Rectum4084658PubMedCrossRef Vernava, AM, Moore, BA, Longo, WE, Johnson, FE 1997Lower gastrointestinal bleedingDis Colon Rectum4084658PubMedCrossRef
73.
go back to reference Molgaard, CP 1997Mesenteric angiography for the diagnosis and treatment of lower gastrointestinal bleedingSemin Colon Rectal Surg816471 Molgaard, CP 1997Mesenteric angiography for the diagnosis and treatment of lower gastrointestinal bleedingSemin Colon Rectal Surg816471
74.
go back to reference Baum, S, Rosch, J, Dotter, CT, et al. 1973Selective mesenteric arterial infusions in the management of massive diverticular hemorrhageN Engl J Med288126972PubMedCrossRef Baum, S, Rosch, J, Dotter, CT,  et al. 1973Selective mesenteric arterial infusions in the management of massive diverticular hemorrhageN Engl J Med288126972PubMedCrossRef
75.
go back to reference Athanasoulis, CA, Baum, S, Rosch, J, et al. 1975Mesenteric arterial infusions of vasopressin for hemorrhage from colonic diverticulosisAm J Surg1292126PubMedCrossRef Athanasoulis, CA, Baum, S, Rosch, J,  et al. 1975Mesenteric arterial infusions of vasopressin for hemorrhage from colonic diverticulosisAm J Surg1292126PubMedCrossRef
76.
go back to reference Goldberger, LE, Bookstein, JJ 1977Transcatheter embolization for treatment of diverticular hemorrhageRadiology1226137PubMed Goldberger, LE, Bookstein, JJ 1977Transcatheter embolization for treatment of diverticular hemorrhageRadiology1226137PubMed
77.
go back to reference Matolo, NM, Link, DP 1979Selective embolization for control of gastrointestinal hemorrhageAm J Surg1388404PubMedCrossRef Matolo, NM, Link, DP 1979Selective embolization for control of gastrointestinal hemorrhageAm J Surg1388404PubMedCrossRef
78.
go back to reference Chuang, VP, Wallace, S, Zornoza, J, Davis, LJ 1979Transcatheter arterial occlusion in the management of rectosigmoidal bleedingRadiology1336059PubMed Chuang, VP, Wallace, S, Zornoza, J, Davis, LJ 1979Transcatheter arterial occlusion in the management of rectosigmoidal bleedingRadiology1336059PubMed
79.
go back to reference Jander, HP, Russinovich, NA 1980Transcatheter Gelfoam embolization in abdominal, retroperitoneal and pelvic hemorrhageRadiology13633744PubMed Jander, HP, Russinovich, NA 1980Transcatheter Gelfoam embolization in abdominal, retroperitoneal and pelvic hemorrhageRadiology13633744PubMed
80.
go back to reference Walker, WJ, Goldin, AR, Shaft, MI, Allibone, GW 1980Per catheter control of haemorrhage from the superior and inferior mesenteric arteriesClin Radiol317180PubMedCrossRef Walker, WJ, Goldin, AR, Shaft, MI, Allibone, GW 1980Per catheter control of haemorrhage from the superior and inferior mesenteric arteriesClin Radiol317180PubMedCrossRef
81.
go back to reference Rosenkrantz, H, Bookestein, JJ, Bosen, RJ, Goff, WB,II, Healy, JF 1982Postembolic colonic infarctionRadiology1424751PubMed Rosenkrantz, H, Bookestein, JJ, Bosen, RJ, Goff, WB,II, Healy, JF 1982Postembolic colonic infarctionRadiology1424751PubMed
82.
go back to reference Hamada, J, Kai, Y, Nagahiro, S, Hashimoto, N, Iwata, H, Ushio, Y 1996Embolization with cellulose porous beads, II: clinical trialAm J Neuroradiol1719016PubMed Hamada, J, Kai, Y, Nagahiro, S, Hashimoto, N, Iwata, H, Ushio, Y 1996Embolization with cellulose porous beads, II: clinical trialAm J Neuroradiol1719016PubMed
83.
go back to reference Herrera, M, Rysavy, J, Kotula, F, Rusnak, B, Castaneda-Auniga, WR, Amplatz, K 1982Ivalon shavings: technical considerations of a new embolic agentRadiology14463840PubMed Herrera, M, Rysavy, J, Kotula, F, Rusnak, B, Castaneda-Auniga, WR, Amplatz, K 1982Ivalon shavings: technical considerations of a new embolic agentRadiology14463840PubMed
84.
go back to reference Dion, JE, Rankin, RN, Vinuela, F, Fox, AJ, Wallace, AC, Mervart, M 1986Dextran microsphere embolization: experimental and clinical experience with radiologic-pathologic correlationRadiology16071721PubMed Dion, JE, Rankin, RN, Vinuela, F, Fox, AJ, Wallace, AC, Mervart, M 1986Dextran microsphere embolization: experimental and clinical experience with radiologic-pathologic correlationRadiology16071721PubMed
85.
go back to reference Kuo, WT, Lee, DE, Saad, WE, Patel, N, Sahler, LG, Waldman, DL 2003Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhageJ Vasc Interv Radiol1415039PubMed Kuo, WT, Lee, DE, Saad, WE, Patel, N, Sahler, LG, Waldman, DL 2003Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhageJ Vasc Interv Radiol1415039PubMed
86.
go back to reference Guy, GE, Shetty, PC, Sharma, RP, Burke, MW, Burke, TH 1992Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particlesAJR Am J Roentgenol1595216PubMed Guy, GE, Shetty, PC, Sharma, RP, Burke, MW, Burke, TH 1992Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particlesAJR Am J Roentgenol1595216PubMed
87.
go back to reference Gordon, R, Ahl, K, Kerlan, R, et al. 1997Selective arterial embolization for the control of lower gastrointestinal bleedingAm J Surg174248PubMedCrossRef Gordon, R, Ahl, K, Kerlan, R,  et al. 1997Selective arterial embolization for the control of lower gastrointestinal bleedingAm J Surg174248PubMedCrossRef
88.
go back to reference Luchtefeld, MA, Senagore, AJ, Szomstein, M, Fedeson, B, VanErp, J, Rupp, S 2000Evaluation of transarterial embolization for lower gastrointestinal bleedingDis Colon Rectum435324PubMedCrossRef Luchtefeld, MA, Senagore, AJ, Szomstein, M, Fedeson, B, VanErp, J, Rupp, S 2000Evaluation of transarterial embolization for lower gastrointestinal bleedingDis Colon Rectum435324PubMedCrossRef
89.
go back to reference Gorich, J, Brambs, HJ, Allenroder, C, et al. 1993The role of embolization treatment of acute hemorrhageRofo15937987PubMed Gorich, J, Brambs, HJ, Allenroder, C,  et al. 1993The role of embolization treatment of acute hemorrhageRofo15937987PubMed
90.
go back to reference DeBarros, J, Rosas, L, Cohen, J, Vignati, P, Sardella, W, Hallisey, M 2002The changing paradigm for the treatment of colonic hemorrhage: superselective angiographic embolizationDis Colon Rectum458028PubMedCrossRef DeBarros, J, Rosas, L, Cohen, J, Vignati, P, Sardella, W, Hallisey, M 2002The changing paradigm for the treatment of colonic hemorrhage: superselective angiographic embolizationDis Colon Rectum458028PubMedCrossRef
91.
go back to reference Bender, JS, Wiencek, RG, Bouwman, DL 1991Morbidity and mortality following total abdominal colectomy for massive lower gastrointestinal bleedingAm Surg5753641PubMed Bender, JS, Wiencek, RG, Bouwman, DL 1991Morbidity and mortality following total abdominal colectomy for massive lower gastrointestinal bleedingAm Surg5753641PubMed
92.
go back to reference Parkes, BM, Obeid, FN, Sorensen, VJ, Horst, HM, Fath, JJ 1993The management of massive lower gastrointestinal bleedingAm Surg596768PubMed Parkes, BM, Obeid, FN, Sorensen, VJ, Horst, HM, Fath, JJ 1993The management of massive lower gastrointestinal bleedingAm Surg596768PubMed
93.
go back to reference Klas, JV, Madoff, RD 1997Surgical options in lower gastrointestinal bleedingSemin Colon Rectal Surg81727 Klas, JV, Madoff, RD 1997Surgical options in lower gastrointestinal bleedingSemin Colon Rectal Surg81727
94.
go back to reference Campbell, WB, Rhodes, M, Kettlewell, MG 1985Colonoscopy following intraoperative lavage in the management of severe colonic bleedingAnn R Coll Engl672902 Campbell, WB, Rhodes, M, Kettlewell, MG 1985Colonoscopy following intraoperative lavage in the management of severe colonic bleedingAnn R Coll Engl672902
95.
go back to reference Cussons, PD, Berry, AR 1989Comparison of the value of emergency mesenteric angiography and intraoperative colonoscopy with antegrade colonic irrigation in massive rectal haemorrhageJ R Coll Surg Edinb34913PubMed Cussons, PD, Berry, AR 1989Comparison of the value of emergency mesenteric angiography and intraoperative colonoscopy with antegrade colonic irrigation in massive rectal haemorrhageJ R Coll Surg Edinb34913PubMed
96.
go back to reference Flickinger, EG, Stanforth, AC, Sinar, DR, MacDonald, KG, Lannin, DR, Gibson, JH 1989Intraoperative video panendoscopy for diagnosing sites of chronic intestinal bleedingAm J Surg15713744PubMedCrossRef Flickinger, EG, Stanforth, AC, Sinar, DR, MacDonald, KG, Lannin, DR, Gibson, JH 1989Intraoperative video panendoscopy for diagnosing sites of chronic intestinal bleedingAm J Surg15713744PubMedCrossRef
97.
go back to reference Desa, LA, Ohri, SK, Hutton, KA, Lee, H, Spencer, J 1991Role of intraoperative enteroscopy in obscure gastrointestinal bleeding of small bowel originBr J Surg781925PubMed Desa, LA, Ohri, SK, Hutton, KA, Lee, H, Spencer, J 1991Role of intraoperative enteroscopy in obscure gastrointestinal bleeding of small bowel originBr J Surg781925PubMed
98.
go back to reference Milewski, PJ, Schofield, PF 1989Massive colonic hemorrhage: the case for right hemicolectomyAnn R Coll Surg Engl712539PubMed Milewski, PJ, Schofield, PF 1989Massive colonic hemorrhage: the case for right hemicolectomyAnn R Coll Surg Engl712539PubMed
99.
go back to reference Rosen, L, Bub, DS, Reed, JF,III, Nastasee, SA 1993Hemorrhage following colonoscopic polypectomyDis Colon Rectum36112631PubMed Rosen, L, Bub, DS, Reed, JF,III, Nastasee, SA 1993Hemorrhage following colonoscopic polypectomyDis Colon Rectum36112631PubMed
100.
go back to reference Lewis B, Waye JD. Bleeding from the small intestine. In: Suguwa C, Schuman BM, Lucas CE, eds. Gastrointestinal bleeding. New York: lgaku-Shoin, 1992:178–88 Lewis B, Waye JD. Bleeding from the small intestine. In: Suguwa C, Schuman BM, Lucas CE, eds. Gastrointestinal bleeding. New York: lgaku-Shoin, 1992:178–88
Metadata
Title
The Management of Lower Gastrointestinal Hemorrhage
Authors
Rebecca E. Hoedema, M.D.
Martin A. Luchtefeld, M.D.
Publication date
01-11-2005
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 11/2005
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-005-0138-1

Other articles of this Issue 11/2005

Diseases of the Colon & Rectum 11/2005 Go to the issue

Letter to the Editor

The Authors Reply