Cause Of Lower Gastrointestinal Bleeding Research Articles

Colonic Dieulafoy lesion successfully treated by endoclips: a rare cause of lower gastrointestinal bleeding.

Colonic Dieulafoy lesion successfully treated by endoclips: a rare cause of lower gastrointestinal bleeding.

Endoscopic management of massive rectal bleeding from a Dieulafoy's lesion: Case report.

BACKGROUNDRectal Dieulafoy's lesions (DLs) are very rare; however, they can be life threatening when presented with massive hemorrhage.CASE SUMMARYA 44-year-old female with medical history of chronic renal failure who was on renal replacement therapy presented with lower gastrointestinal hemorrhage. Physical examination revealed signs of hypovolemic shock and massive rectal bleeding. Complete blood count revealed abrupt decrease in hematocrit. After hemodynamic stabilization, an urgent colonoscopy was performed. A rectal DL was diagnosed, and it was successfully treated with two hemoclips. There were no signs of recurrent bleeding at thirty days of follow-up.CONCLUSIONRectal DLs represent an unusual cause of lower gastrointestinal bleeding. Massive hemorrhage can increase the morbidity and mortality of these patients. Endoscopic management continues to be the reference standard in the diagnosis and therapy of these lesions. Thermal, mechanical (hemoclip or band ligation), or combination therapy (adrenaline injection combined with thermal or mechanical therapy) should be considered the first choice for treatment.

Clinical Spectrum of Chronic Lower Gastrointestinal Bleeding in Sub-Himalayas: A Study at a Tertiary Care Hospital of North India

Abstract Background Lower gastrointestinal bleeding (LGIB) is fairly a common presentation in gastroenterology and medicine departments, and presents major diagnostic and therapeutic challenges. This study aimed to explore the varied clinical spectrum of LGIB in our region. Methods A total of 138 patients presented with chronic LGIB and were investigated using colonoscopy and relevant investigations. Results The majority of patients were in the age group of 40 to 59 years, with a mean age of 49.5 years, slight male predominance, and male-to-female ratio of 1.19:1. The most common clinical presentation was hematochezia (97.8%). Overall, 15% patients had more than one comorbidity, and 39.13% patients were anemic, of which 7.24% received blood transfusions. Diagnostic yield of colonoscopy was 92.75%.Major causes of LGIB were anorectal causes (19.56%), inflammatory bowel disease (19.56%), colorectal carcinoma (17.39%), radiation proctitis (9.42%), infective causes (11.59%), nonspecific colitis (7.24%), and benign growths (5.07%). However, in the elderly (age > 60 years), carcinoma colon, radiation proctitis, and hemorrhoids predominated the clinical picture. Conclusion Colonoscopy is very useful in the evaluation of patients with LGIB. The predominant causes of LGIB vary according to age as well as geographical location, and mortality of LGIB is negligible as compared with upper gastrointestinal bleeding.

To Determine the Frequency of the Common Causes of Lower Gastrointestinal Bleeding after Colonoscopy

Introduction: Lower Gastrointestinal Bleeding (LGIB) is defined as bleeding from distal to the ligament of Treitz at the duodeno-jejunal flexure and it accounts for 30-40% of all gastrointestinal bleeding. Although it is less common than the upper gastrointestinal bleeding yet considered as medical and surgical emergency particularly when massive. The leading causes of LGIB are hemorrhoids, rectal ulcers, rectal polyps and colitis; while less frequent causes include ulcerative colitis, Crohn's disease and diverticulitis. This is apparently in contrast to the western literature where inflammatory bowel diseases and diverticulitis are the common cause of LGIB. Presently Colonoscopy is the diagnostic and therapeutic procedure of choice in LGIB.
 Objective: To determine the frequency of the common causes of lower gastrointestinal bleeding (LGIB) after Colonoscopic examination in a tertiary care hospital of Lahore.
 Methodology: This cross-sectional descriptive study was conducted at Department of Gastroenterology, Services institute of Medical Sciences Lahore (SIMS) from April 2016 to March 2017.
 Results: A total of 277 patients were included in this study, 181(65.34%) were males and 96(34.65%) were females. The average age oi the patients was 45.5 years. Colonoscopy showed abnormal findings in 219 (79.06%) patients. The internal hemorrhoids were the most common cause of LGIB while least common cause of LGIB after Colonoscopic examination was malignant lesions of colon and rectum.
 Conclusion: In our study bleeding from internal hemorrhoids was the leading cause of lower gastrointestinal bleeding followed by rectal ulcers and polyps.
 
 Keywords: Lower GI Bleeding, Hemorrhoids, Rectal Ulcer, Rectal polyps, Colonoscopy.

Endoscopic Findings in Children with Isolated Lower Gastrointestinal Bleeding.

Background/AimsColorectal polyps are a common cause of lower gastrointestinal bleeding in children. Our aim was to study the causes of isolated lower gastrointestinal bleeding and to analyze the characteristics of the colorectal polyps found in our cohort. MethodsWe retrospectively reviewed colonoscopic procedures performed between 2007 and 2015. Children with isolated lower gastrointestinal bleeding were included in the study. ResultsA total of 185 colonoscopies were performed for isolated lower gastrointestinal bleeding. The median patient age was 8 years, and 77 patients (41.6%) were found to have colonic polyps. Normal colonoscopy findings were observed and acute colitis was detected in 77 (41.6%) and 14 (7.4%) patients, respectively. Single colonic polyps and 2–3 polyps were detected in 73 (94.8%) and 4 (5.2%) patients with polyps, respectively. Of the single polyps, 69 (94.5%) were juvenile polyps, among which 65 (94.2%) were located in the left colon. ConclusionsSingle left-sided juvenile polyps were the most common cause of isolated lower gastrointestinal bleeding in our study. It was rare to find multiple polyps and polyps proximal to the splenic flexure in our cohort. A full colonoscopy is still recommended in all patients in order to properly diagnose the small but significant group of patients with pathologies found proximal to the splenic flexure.

Etiology of lower gastrointestinal bleeding in Sulaimani governorate-Kurdistan region-Iraq- retrospective cross-sectional study

BackgroundAcute lower gastrointestinal bleeding is arbitrarily defined as bleeding of less than 3 days in duration, while chronic lower gastrointestinal bleeding is the passage of blood from the rectum over a period of several days or longer and usually implies that blood loss is intermittent or slow. ObjectivesTo find the causes of lower gastrointestinal bleeding and to find the commonest cause to raise awareness of the gastroenterologist personnel, surgeons and internists. Patients and methodsThe study was conducted as a retrospective cross-sectional study, 734 patients from a total number of 854 patients, underwent colonoscopy in Kurdistan Center for Gastroenterology and Hepatology in Sulaimani governorate, Kurdistan region-Iraq, were recruited, it took a period of 10 months; from 2nd January 2018 to 31st October in 2018. Clinical examination, digital rectal examination, and colonoscopy with biopsy were arranged for each patient. ResultsBleeding due to hemorrhoid was the most frequent diagnosis (n = 211, 28.74%) which reported during colonoscopy, which was more common in males (n = 113, 15.3%) than females (n = 98, 13.3%) with female to male ratio of (0.86). ConclusionThe most common cause of lower gastrointestinal bleeding in the area is hemorrhoid. Colonoscopy is superior to physical and digital rectal examination in detecting cause of bleeding in lower GIT bleeding.

Angiodysplasia of left colon extending to anal verge landed patient into APR: a rare finding

Angiodysplasias is a kind of vascular malformation preferably involves the veins. Angiodysplasia of colon is the second most common cause of lower gastrointestinal bleeding after diverticulosis. It usually involves caecum and ascending colon. Patient may either present with complaints of fresh bleeding per rectum or with melena. It usually occurs in elderly because of age related degeneration of small blood vessel walls. The case presented here involves a male patient of 25-year age with complains of intermittent bleeding per rectum and generalized weakness from one month. After examination it was found to have vascular ectasia involving mid transverse colon, left colon and the rectum coming down to anal verge which culminated into abdominoperineal resection. Biopsy of resected segment came to be angiodysplasia with external surface of specimen showing dilation of multiple vascular channels in entire length up to anal verge. This case report shows that though angiodysplasia is more common in old age but while exploring a young patient with lower gastrointestinal tract bleeding, and congestive changes are found in left colon possibility of angiodysplasia should also be kept in mind.

Polypectomy for Colonic Arteriovenous Malformation

A 59-year-old Caucasian female with a past medical history of hypertension presented for a routine screening colonoscopy. The patient denied any symptoms of melena, hematochezia, fatigue, shortness of breath, or palpitations. Significant medications included Aspirin 81 mg once per day. Her hemoglobin was stable at 13.5 g/dL and platelet count was 256 x 103 platelets/mL. Colonoscopy revealed a 7 cm elongated polyp-like lesion with a narrow slit-like opening in the descending colon, 50 cm from anal verge (figure 1). There was initial concern for an inverted diverticulum but was thought to be unusually long. Mucosal biopsy showed normal colonic mucosa. In view of unexplained etiology of the structure and polypoidal appearance, colonoscopy was repeated with an intention of performing polypectomy to rule out an underlying adenoma. During colonoscopy an endoloop was deployed at the base of the elongated polypoidal structure and a hot snare polypectomy was performed excising the lesion. Three endoclips were placed at the base of the lesion to prevent post-polypectomy bleeding (figure 2). Adjacent colon was tattooed with endospot just proximal to the polypectomy site. The histological examination of the specimen revealed it to be a polyp-like colonic arteriovenous malformation (AVM). A colonoscopy was subsequently repeated after 6 month and the post polypectomy site identified by the tattoo placement showed no gross abnormality. Colonic AVMs are a very common cause of lower gastrointestinal bleeding. They are most commonly found in the right colon with a typical gross appearance of flat, bright red submucosal blood vessels that have an ectatic and/or tortuous characteristic. A pedunculated polypoid appearance of these lesions in the colon isextremely rare and has scarcely been reported in the literature. We present this case to increase awareness amongst Gastroenterologists regarding polypoidal variant of colonic AVM and successful endoscopic management adopting measures to prevent post- polypectomy bleeding.1629_A Figure 1 No Caption available.1629_B Figure 2 No Caption available.

Donʼt Stop Looking: Lower Gastrointestinal Hemorrhage Secondary to Appendiceal Orifice Bleeding

The patient is a 53 year old male who presented to the hospital with anemia and gastrointestinal hemorrhage. The decision was made to pursue an endoscopic work up with upper endoscopy and a colonoscopy. The upper endoscopy was nondiagnostic, however a large amount of hematochezia noted during his colonoscopy. Further work up with a bleeding scan did not reveal active bleeding, prompting us to pursue a capsule endoscopy. There was an area of active bleeding noted in the distal small bowel which led to patient being scheduled for retrograde double balloon enteroscopy. During this procedure, diligent attention was made to irrigate and suction remaining blood throughout the colon. After the cecum was thoroughly cleaned, a slow ooze was noted emanating from the appendiceal orifice. Withdrawal of the scope did not reveal any other potential source of bleeding. The patient subsequently underwent an appendectomy resulting in successful treatment of his hemorrhage. The specimens from surgical pathology did not reveal any obvious abnormality. The patient was subsequently discharged without any signs of overt hemorrhage. Appendiceal orifice hemorrhage is a rare cause of lower gastrointestinal hemorrhage, as there are only few case reports noted in the literature. This type of bleeding can result from ulcers, erosions, angiodysplasias, or malignancy. Appendectomy is generally curative as it was in our patient's case. This case highlights the need to remain persistent while attempting to diagnose an acute lower GI bleed

Management of Diverticular Bleeding: Evaluation, Stabilization, Intervention, and Recurrence of Bleeding and Indications for Resection after Control of Bleeding

Diverticular bleeding is the most common cause of lower gastrointestinal bleeding with nearly 200,000 admissions in the United States annually. Less than 5% of patients with diverticulosis present with diverticular bleeding and present usually as painless, intermittent, and large volume of lower gastrointestinal bleeding. Management algorithm for patients presenting with diverticular bleeding includes resuscitation followed by diagnostic evaluation. Colonoscopy is the recommended first-line investigation and helps in identifying the stigmata of recent hemorrhage and endoscopic management of the bleeding. Radionuclide scanning is the most sensitive but least accurate test due to low spatial resolution. Angiography is helpful when patients are actively bleeding and therapeutic interventions are performed with angioembolization. Surgery for diverticular bleeding is necessary when associated with hemodynamic instability and after failed endoscopic or angiographic interventions. When the bleeding site is localized preoperatively, partial colectomy is sufficient, but subtotal colectomy is necessary when localization is not possible preoperatively.

Etiological Profile of Patients Presenting with Lower Gastrointestinal Bleeding in Ibb Governorate-Yemen

Objectives: To investigate the causes of lower gastrointestinal bleeding (LGIB) in Yemeni patients and to compare our results with the results of other studies. Design: Prospective study of patients with overt LGIB during the period from April 2017 to March 2018. Setting: Specialized center of gastrointestinal and liver diseases in Ibb city, Yemen. Subjects & Method: Consecutive patients who presented or referred to our center with LGIB to whom lower GI endoscopy was performed. Results: During the study period, we had 122 patients with LGIB, 72 were males and 50 were females, with male:female ratio of 1.4:1 The age ranged between 5 and 82 years and the mean age was 45 ± 17.99 years. The clinical presentations of our patients included hematochezia in 72.1%, abdominal pain in 51.7%, diarrhea in 43.3%, pallor, and anemia in 40.2%, weight loss in 39.3%, constipation in 16.4%, bloody diarrhea in 16.4%, and melena in 5.7%. The most common colonoscopic findings were hemorrhoids in 36.7% followed by colon cancer in 19.7% and nonspecific colitis in 15.6%. Conclusion: Hemorrhoids and colon cancer were the most common causes of lower GI bleeding in our patients.

Risk factors for severity of colonic diverticular hemorrhage.

Background/AimsColonic diverticular hemorrhage (DH) was a rare disease until the 1990s, and its incidence has increased rapidly since 2000 in Japan. In recent years, colonic DH has been the most frequent cause of lower gastrointestinal bleeding (LGIB). Nearly all cases of DH are mild, with the bleeding often stopping spontaneously. Some cases, however, require surgery or arterial embolization. In this study, using a cohort at Fukuoka University Chikushi Hospital, we investigated factors associated with severe colonic DH.MethodsAmong patients with LGIB who underwent colonoscopy at our hospital between 1995 and 2013, DH was identified in 273 patients. Among them, 62 patients (22.7%) were defined as having severe colonic DH according to recurrence of bleeding in a short period, and/or the necessity of transfusion, arterial embolization, or surgery. We then evaluated risk factors for severe DH among DH patients in this retrospective cohort.ResultsAmong the 273 patients with DH, use of non-steroidal anti-inflammatory drugs (NSAIDs) (odds ratio [OR], 2.801; 95% confidence interval [CI], 1.164–6.742), Charlson Risk Index (CRI) ≥2 (OR, 3.336; 95% CI, 1.154–7.353), right-sided colonic DH (OR, 3.873; 95% CI, 1.554–9.653), and symptoms of cerebral hypoperfusion (such as light-headedness, dizziness, or syncope) (OR, 2.926; 95% CI, 1.310–6.535) showed an increased risk of severe DH even after controlling for other factors.ConclusionsSevere DH occurred in 23% of DH patients, and NSAID use, CRI ≥2, right-sided colonic DH, and symptoms of cerebral hypoperfusion are suggested to be predictors of severe DH.

Factors associated with diverticular bleeding and re-bleeding: A United States hospital study.

OBJECTIVE:Diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Arteriovascular disease, metabolic syndromes, non-steroidal anti-inflammatory drugs (NSAIDs), anti-thrombotics, and anticoagulants have been suggested as risk factors. There is a paucity of studies addressing factors associated with diverticular re-bleeding, especially in the United States. The aim of this study is to evaluate factors associated with colonic diverticular bleeding and re-bleeding in a US community-based hospital.METHODS:We conducted a retrospective case-control study to analyze the factors associated with diverticular bleeding. Between January 2010 and July 2011, 93 patients were admitted to our hospital with a primary diagnosis of acute diverticular bleeding. We compared them to 152 patients who were admitted with a primary diagnosis of diverticulitis in the same period. We collected data from the medical records of each patient in relation to the demographics, comorbidities, medications, social habits, location of diverticulosis, length of stay in the hospital, and re-bleeding rate within 2 years of the first bleeding episode.RESULTS:Factors such as cerebrovascular accident (p=0.009), coronary artery disease (p=0.037), diabetes mellitus (p=0.046), obstructive sleep apnea (p=0.033), NSAIDs (p=0.038), use of anti-thrombotics (p=0.001), anticoagulants (p=0.002) or calcium channel blockers (p=0.009), and bilateral diverticulosis (p=0.001) were significantly associated with diverticular bleeding as compared to diverticulitis. Recurrence of bleeding was noted in 26 out of 93 patients (28%) within 2 years of the first bleeding episode (p=0.001). Bilateral colonic involvement, anticoagulants, and elderly age (≥65 years) were found to have a closer relationship to diverticular re-bleeding, although it was not statistically significant.CONCLUSION:This study reveals that arteriovascular disease, diabetes mellitus, NSAIDs, the use of anti-thrombotics, anticoagulants or calcium channel blockers, and obstructive sleep apnea are factors that are significantly associated with diverticular bleeding. It also shows that bilateral colonic involvement, elderly age, and anticoagulants have a closer relationship to diverticular re-bleeding. More prospective studies in patients with diverticular bleeding should be conducted to shed light on the causality of these factors and the prevalence of diverticulitis.

A Rare Cause of Lower Gastrointestinal Bleed: Internal Iliac Aneurysm With Rupture into Rectum

An 85-year-old male with history of atrial fibrillation for which he was on warfarin, tobacco use, and vascular disease presented with acute onset of pulsatile rectal hemorrhage followed by unresponsiveness. Physical examination revealed confusion and tachycardia with a benign abdomen. Labs revealed a two-gram hemoglobin drop and INR of 5. The patient was resuscitated and coagulopathy was reversed. Enhanced CT abdomen/pelvis revealed a 2.2 x 1.8 cm distal right internal iliac artery aneurysm with contained rupture, evidenced by a 2.5 x 2.2 medially projecting pseudoaneurysm (Figure A). There was no enteric endoluminal extravasation of contrast to suggest a fistula, although presentation was suggestive of one. An urgent angiogram revealed an aneurysm arising from a distal branch of the anterior division of the right internal iliac artery, with no active extravasation (Figure B). Coil embolization of the outflow artery was performed (Figure C). The inflow artery to the aneurysm was then embolized and follow-up angiogram showed no additional feeding vessels into the aneurysm. Following the procedure, there was no further hematochezia and the hemoglobin remained stable. A literature search for ruptured internal iliac artery aneurysm with fistulization to the colon mainly showed cases occurring secondary to vasculitis or previous vascular reconstructive surgery. Primary fistulae occur most frequently between the aorta and esophagus or duodenum. Primary iliac-enteric fistulae are rare, occurring in about 0.07% of the general population.1 However, this is a possible cause of brisk lower gastrointestinal bleeding and should be considered in the differential of these patients. A small case series describing six patients with primary aorto/iliac-enteric fistulae found the overall 30-day mortality rate to be 50%.2 If there is suspicion for this, an enhanced CT scan should be obtained immediately as proceeding with endoscopic evaluation will only delay definitive therapy.FigureFigureFigure

Development of Bleeding Gastric Arteriovenous Malformations in a 23-year-old Man 3 Months After Normal Endoscopy

Gastric arteriovenous malformations (AVMs) are extremely rare. AVMs can develop in the stomach, large and small intestine. They are typically seen in elderly patients and are most commonly found in the large intestine. They are a significant cause of lower gastrointestinal bleeding in elderly patients. AVMs are more common in patients with end-stage kidney disease, Von Willebrand disease and have been found to be associated with aortic stenosis. A 23 year-old Caucasian male was brought in to the hospital by his mother after he had an episode of coffee ground emesis associated with fever and a low oxygen saturation level measured at home by his caretaker. He has a past medical history of an anoxic brain injury from a childhood drowning accident at age 4, with a gastrojejunostomy tube for feeding. In the emergency room, he was found to have hypoxia and was admitted to the hospital. His physical exam revealed blood pressure of 73/51 and an oxygen saturation of 85%. Admission labs revealed hemoglobin of 15.3 g/dl, hematocrit of 43.8%, MCV 94.2 and WBC 8,900. A chest x-ray performed during hospitalization revealed a left lung consolidation suspicious for possible aspiration pneumonia. Blood work on the following day showed his hemoglobin had dropped to 7.9 g/dl with a hematocrit of 23% and he continued to have episodes of coffee ground emesis. An endoscopy was performed that revealed several medium-sized angiodysplastic lesions with stigmata of recent bleeding in the gastric body and underneath the g-tube bumper. Hemostasis was achieved with argon laser and the patient did not have any further episodes of hematemesis. The patient had a previous endoscopy that was performed 3 months prior to hospitalization evaluating for reflux esophagitis which had revealed normal gastric and duodenal mucosa. No AVMs were seen at that time. In this case, a young male patient developed gastric AVMs in a span of 3 months that were associated with significant bleeding, leading to aspiration pneumonia. The patient does not have end-stage renal disease, aortic stenosis or Von Willebrand disease. The pathogenesis of AVMs of the gastrointestinal tract is not well understood. In this patient, it is possible that previous hospitalization with significant hypoxia may have led to the increased expression of angiogenic factors which may be the underlying reason for the development of arteriovenous malformations of the stomach in a short period of time.Figure: Endoscopic view of multiple a/v malformations in patient's stomach.Figure: Endoscopy performed 3 months ago.

Etiological profile of patients presenting with lower gastrointestinal bleeding at tertiary care hospital at Belagavi: a cross sectional study

Background: Lower gastrointestinal bleeding (LGIB) is bleeding arising below the ligament of Treitz. Hemorrhage from the lower gastrointestinal (GI) tract accounts for about 20% of all cases of acute GI bleeding. Lower GI bleeding is that which occurs from the colon, rectum, or anus, and presenting as either hematochezia (bright red blood or red wine color stools) or malena, blood streaking of the stool. The objective of this study was to evaluate the etiological profile of patients presenting with lower gastrointestinal bleeding.Methods: This one-year cross-sectional study was conducted in the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi from January 2015 to December 2015. The study design was a cross-sectional study. This study was carried out from January 2015 to December 2015. Patients with lower gastro-intestinal bleeding presenting at Department of Medicine and Department of Gastro-enterology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi were studied.Results: In the present study majority of the patients were males with the mean age was 43.82±17.96 years and majority of the patients were married with moderate built and nourishment. As per the occupation majority were housewives followed by students. In the present study diabetes mellitus was the most common medical history reported. Internal haemorrhoids was significantly associated with male sex, student’s profession followed by housewife with mixed diet consumption, the clinical presentations significantly associated with internal haemorrhoids were haematochezia, loss of appetite, tenesmus, passage of mucus in stools, constipation, abdominal pain and vomiting.Conclusions: Internal hemorrhoids is the most common cause followed by ulcerative colitis. Though not common, carcinoma colon, solitary rectal ulcer syndrome, polyp, colonic diverticulosis, ischaemic colitis, non-specific proctitis, and radiation proctitis are the other causes of LGIB.

Ileocolic intussusception of ileal lipoma as a cause of lower gastrointestinal bleeding

Ileocolic intussusception of ileal lipoma as a cause of lower gastrointestinal bleeding

Lower gastrointestinal bleeding\u2014Computed Tomographic Angiography, Colonoscopy or both?

BackgroundLower endoscopy (LE) is the standard diagnostic modality for lower gastrointestinal bleeding (LGIB). Conversely, computed tomographic angiography (CTA) offers an immediate non-invasive diagnosis visualizing the entire gastrointestinal tract. The aim of this study was to compare these 2 modalities with regards to diagnostic value and bleeding control.MethodsTertiary center retrospective analysis of consecutive patients admitted for LGIB between 2006 and 2012. Comparison of patients with LE vs. CTA as first exam, respectively, with emphasis on diagnostic accuracy and bleeding control.ResultsFinal analysis included 183 patients; 122 (66.7%) had LE first, while 32 (17.5%) had CTA; 29 (15.8%) had neither of both exams. Median time to CTA was shorter compared to LE (3 (IQR = 8.2) vs. 22 (IQR = 36.9) hours, P < 0.001). Active bleeding was identified in 31% with CTA vs. 15% with LE (P = 0.031); a non-actively bleeding source was found by CTA and LE in 22 vs. 31%, respectively (P = 0.305). Bleeding control required endoscopy in 19%, surgery in 14% and embolization in 1.6%, while 66% were treated conservatively. Post-interventional bleeding was mostly controlled by endoscopic therapy (57%). 80% of patients with active bleeding on CTA required surgery.ConclusionsPost-interventional LGIB was effectively addressed by LE. For other causes of LGIB, CTA was efficient, and more available than colonoscopy. Treatment was conservative for most patients. In case of active bleeding, CTA could localize the bleeding source and predict the need for surgery.

Spectrum of the causes of lower gastrointestinal bleeding in geriatric patients in tertiary care hospital

Context: Lower gastrointestinal bleeding (LGIB) patients in geriatric are the common indication of hospital admissions, with marked geographic variation in the frequency of different etiologies. Colonoscopy is considered as first-line diagnostic procedure of choice in evaluation of patients with bleeding per rectum. Aims: This study aims to determine spectrum of LGIB in our region using lower gastrointestinal (GI) endoscopy. Settings and Design: A retrospective study of 2-year period from August 2010 to July 2012, 2 years study in tertiary hospital. Subjects and Methods: The clinical data of patients admitted with per rectal bleeding were collected including age, sex, site of bleeding and the underlying cause. In all cases proctoscopy was done and colonoscopy after preparation and stabilization of the patients. Statistical Analysis Used: SPSS analysis. Results: During 2-year follow-up study, 45 patients were admitted with LGIB with mean age of 67.5 years, the bleeding site was in the colorectal causes found in 33 (73.3%) cases, while perianal in 6 (13.3%) of cases. Carcinoma was the most common cause. Conclusions: Bleeding per rectum is a common cause in geriatric patients admitted to Gastroenterology Department. Carcinoma is the most common cause of bleeding per rectum. There is wide geographic variation regarding the etiologies of LGIB. Lower GI endoscopy is very useful tool in evaluating patients with bleeding per rectum.

Clinico-etiological pattern of lower gastrointestinal bleeding in children (5-18 years age group) at a tertiary care center in central India

Background: Lower gastrointestinal bleeding (LGIB), defined as bleeding occurring distal to the ligament of Treitz, is a common presenting symptom in pediatric patients. Objective: To understand the clinico-etiological pattern of LGIB in children in the age group 5-18 years. Materials and Methods: This prospective study was carried out at a tertiary health-care center in central India between January 2011 and August 2012. We consecutively enrolled all patients in the age group 5-18 years who came to our center with gross LGIB or two consecutive positive occult blood tests with at least 1-week interval between tests. All patients underwent colonoscopy (small, flexible Olympus PCF-20 colonoscope) and the findings were recorded. The procedure was done only after proper informed consent from the parents. Results: Total 38 patients were included in the study with above-mentioned inclusion and exclusion criteria, during the study period. Male to female ratio in LGIB was 2.16:1. LGIB was most common in children aged 5-10 years (63.1%), followed by 10-14 years (26.3%). Hematochezia was the most common presenting symptom (78.9%) followed by melena (21.1%). The most common causes of LGIB were colitis and colorectal polyp (31.6% each) followed by anal fissures (21.1%). Anemia was present in 68.4% patients at the time of presentation. Recurrence of LGIB was noted in 18 (47.4%) patients. Conclusion: We conclude that LGIB is most common in 5-10 years of children (school age) with hematochezia as the most common presenting symptom. Causes of LGIB in children in developing countries are same as developed countries (polyps and colitis being most common, followed by anal fissure), but further studies are required to determine the significant correlation between findings.