Abstract
Gastrointestinal (GI) bleeding from the colon is a communal reason for hospitalization and is being more frequent in older patients. Gastrointestinal bleeding is known as any bleeding that takes place in the GIT from mouth to anus. Lower GI bleeding is defined as bleeding distal to the ligament of Treitz. Lower GI bleed is typically presented as hematochezia which is the passing of bright red blood clots or burgundy stools through the rectum. The causes of lower GI bleeding are changing over the past several decades from diverticulosis (which is the protrusion of the colon wall at the site of penetrating vessels), infectious colitis, ischemic colitis, angiodysplasia, inflammatory bowel disease, colon cancer, hemorrhoids, anal fissures, rectal varices, dieulafoy lesion, radiation-induced damage following cancer treatment to post-surgical. Management of lower GI bleeding is done through assessing the severity of symptoms and the condition of the overall case.
Highlights
Bleeding beyond the ligament of Treitz, which is a thin band that links the ending of duodenum and the beginning of jejunum in the gastrointestinal tract (GIT) or called the suspensory muscle of duodenum, is considered as bleeding in the lower GIT, the term lower gastrointestinal bleeding is a misnomer and should be called lower intestinal bleeding instead [1, 2]
Bleeding above the ligament of Treitz, which is called upper gastrointestinal bleeding, is presented as either hematemesis or melena, hematemesis is the regurgitation of blood or blood mixed with stomach contents whereas melena is dark, black, and tarry faeces that has a strong distinctive odor caused by the activity of digestive enzyme and intestinal bacteria on hemoglobin
Upper GI bleeding mainly occurs in the esophagus, stomach, or duodenum, whereas lower GI bleeding occurs in small bowel, colon, or anorectum
Summary
Bleeding beyond the ligament of Treitz, which is a thin band that links the ending of duodenum and the beginning of jejunum in the gastrointestinal tract (GIT) or called the suspensory muscle of duodenum, is considered as bleeding in the lower GIT, the term lower gastrointestinal bleeding is a misnomer and should be called lower intestinal bleeding instead [1, 2]. Bleeding above the ligament of Treitz, which is called upper gastrointestinal bleeding, is presented as either hematemesis or melena, hematemesis is the regurgitation of blood or blood mixed with stomach contents whereas melena is dark, black, and tarry faeces that has a strong distinctive odor caused by the activity of digestive enzyme and intestinal bacteria on hemoglobin. Bleeding below the ligament of Treitz, which is called lower gastrointestinal bleeding, is presented as hematochezia, which is the passing of bright red blood clots or burgundy stools through the rectum [4, 5]. Diagnosis, as well as intervention are needed in the cases that do not resolve spontaneously, or presented with severe hematochezia which is seen as ongoing bleeding in the first 24 hours of hospitalization with a minimumfall in the hemoglobin of 2 g/dL and/or a need for transfusion of 2 units of packed red blood cells or more [13]
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