Cause Of Lower Gastrointestinal Bleeding Research Articles

Contrast-enhanced computed tomography assisted diagnosis of bleeding caused by colonic angiodysplasia: A case report.

Angiodysplasia (AD) in the gastrointestinal tract is a degenerative vascular condition characterized by vascular dilation, tortuosity, and arteriovenous connections within the mucosal and submucosal layers. AD is a significant cause of lower gastrointestinal bleeding in the elderly, often presenting as chronic, intermittent hemorrhage. The research challenge lies in the potential for multiple and minute AD lesions to be missed during endoscopy, which may lead to post-hemostatic rebleeding. An 82-year-old female with a history of coronary artery disease treated with aspirin, presenting with recurrent melena and anemia. The patient exhibited a suboptimal response to blood transfusions and octreotide therapy. After excluding tumorous bleeding in the initial contrast-enhanced computed tomography (CECT), we suspect vascular bleeding as the most probable etiology. The initial colonoscopy was unsuccessful due to the occurrence of ventricular tachycardia. Considering the patient's advanced age, cardiac dysfunction, and frailty, a repeat CECT were conducted during episodes of suspected active bleeding. Vascular dilatation within the colonic hepatic flexure wall was visualized during the venous phase, accompanied by contrast agent extravasation into the intestinal lumen. The subsequent urgent colonoscopy and pathological specimens from surgical resection supported the diagnosis of colonic AD. After the surgery, the patient did not experience melena thereafter. We highlight that CECT for diagnosing AD-related bleeding offers higher safety and convenience, potentially superior to digital subtraction angiography, particularly in critically ill elderly patients.

Portal Hypertensive Mayhem: A Case Report of Colonic Variceal Bleeding Treated by Antegrade Embolization

AbstractIn patients with cirrhosis of the liver, acute variceal bleeding can be fatal. Bleeding colonic varices is a very rare cause of lower gastrointestinal bleeding that can result in massive hemorrhage in patients with cirrhosis. Here we present the case of a 50-year-old gentleman, having cirrhosis of the liver with chronic portal vein occlusion, who presented with massive bleeding per rectum. Contrast computed tomography (CT) revealed a large shunt arising from the superior mesenteric vein forming submucosal colonic varices and joining the right renal vein. He underwent successful obliteration of the varix by antegrade endovascular embolization via the trans-splenic access. Endovascular embolization could be an effective and life-saving treatment option for colonic variceal bleeding.

Enfermedad diverticular

Diverticula are sac-like protrusions that appear in the weak points of the colon wall. They are usually asymptomatic. Diverticular disease develops when symptoms appear. Its etiopathogenesis is likely multifactorial, although it is not fully known. Complicated diverticulosis includes acute diverticulitis, which is the most frequent complication and one of the most common reasons for consultation in emergency departments, and diverticular hemorrhage, one of the most frequent causes of lower gastrointestinal bleeding in our setting. A diagnosis of acute diverticulitis is established through an abdominal computed tomography scan. A diagnosis of hemorrhage is established by performing a full colonoscopy, for which adequate prior preparation of the patient by means of taking an oral laxative solution is recommended. The treatment of acute diverticulitis has classically been based on the use of antibiotics, although current evidence supports a decrease in the use of antibiotic treatment in patients with uncomplicated acute diverticulitis. In this disease, antibiotics must target a polymicrobial etiology consisting mainly of gram-negative and anaerobic bacilli.

Predictors of in-hospital outcomes for diverticular bleeding patients: a retrospective analysis of National Inpatient Sample data (2016-2020).

Diverticular bleeding is the leading cause of lower gastrointestinal bleeding, affecting 3-5% of patients with diverticulosis. Current management protocols include resuscitation, diagnosis via direct visualization, computed tomography imaging, endoscopic interventions, angioembolization, and surgery when needed. However, predictive factors for outcomes and optimal interventions remain ambiguous. This retrospective cohort study analyzed data from the National Inpatient Sample (NIS) database (2016-2020) to determine predictors of adverse in-hospital outcomes in diverticular bleeding patients without perforation or abscess. Demographic and clinical data were extracted, and multivariate regression models were applied. Analysis was conducted using R statistical software (version 4.1.3), with significance set at P<0.05. A total of 28,269 patients hospitalized for diverticular bleeding were identified. Age >85 years, moderate to severe Charlson Comorbidity Index, hypovolemic shock, blood transfusion requirement, and requirement for colectomy were significantly associated with greater in-hospital mortality. Factors such as late colonoscopy timing and colon resection led to longer hospital stays, while arterial embolization was predicted by older age, Black race, hypovolemic shock, and blood transfusion. Predictors of colon resection included advanced age, presence of colon cancer, and hypovolemic shock. Our retrospective study identified significant predictors of in-hospital outcomes among patients with diverticular bleeding, informing risk stratification and management strategies. Further research is warranted to validate these findings and refine management algorithms for improved patient care. Integrating these insights into clinical practice may enhance outcomes and guide personalized interventions in diverticular bleeding management.

Diagnostic Yield of Colonoscopy in Patients Presenting with Lower Gastrointestinal Bleeding at a Tertiary Care Center

Abstract Background and Aims: Lower gastrointestinal bleeding (LGIB) poses a significant challenge in clinical practice due to its diverse etiologies and potential for serious morbidity and mortality. Colonoscopy is the preferred, valuable diagnostic tool for identifying the underlying cause of LGIB. This study aimed to evaluate colonoscopic findings in patients presenting with LGIB at a tertiary care hospital in Baghdad. Subjects and Methods: This retrospective descriptive study reviewed records of patients, who underwent colonoscopy for LGIB, at the Gastroenterology and Hepatology Teaching Hospital in Baghdad Governorate between January 1 and July 31, 2023. The analysis included age, sex, and endoscopic findings. Results: A total of 228 patients were included, with 124 (54.4%) males and 104 (45.6%) females. The mean age was 39.23 ± 20.57 years. A colonoscopy revealed a diagnostic yield of 68.0%. LGIB was more prevalent among individuals aged 40 years and younger (53.5%). The most common colonoscopic finding was hemorrhoids (20.2%), followed by polyps (13.1%), colitis (9.2%), ulcerative colitis (8.3%), and colorectal cancer (7.9%). Conclusion: This study underscores the importance of colonoscopy in evaluating LGIB. Larger, multicenter studies are recommended to validate these findings and guide clinical practice in LGIB management.

Clinical features, treatments and prognosis of appendiceal bleeding: a case series study

BackgroundAppendiceal bleeding is a rare cause of lower gastrointestinal bleeding, could be overlooked and diagnosed as obscure gastrointestinal bleeding. Due to limited real-world cases, the optimized management of appendiceal bleeding is unclear. We here shared our experiences in the past 20 years.MethodsA retrospective study was conducted at West China Hospital of Sichuan University. We reviewed data of 28,175 colonoscopies from 43,095 gastrointestinal bleeding patients between June 2003 and June 2023. Six patients diagnosed as appendiceal bleeding were included. Data including symptoms, laboratory tests, imaging results, endoscopic findings, treatment and prognosis were collected and analyzed.ResultsAppendiceal bleeding accounts for 0.014% in gastrointestinal bleeding patients. Of the six patients, five were male, with a mean age of 48.5 years. Hematochezia was the most common symptom. The etiology included appendiceal angiodysplasia, appendicitis and appendectomy associated bleeding. Hemostasis was achieved by appendectomy, endoscopic therapy or medication according to different cases. One patient did not receive any treatment because of self-limiting bleeding.ConclusionsThe diagnosis of appendiceal bleeding is challenging, repeated flushing during endoscopy is helpful. Appendectomy is the priority option for treatment as well as the etiology clarification, therapeutic endoscopy and medication could be considered case by case.

Woman With Hematochezia.

As a consequence of cirrhosis, portal hypertension causes resistance to blood flow and leads to the formation of varices. However, colonic variceal hemorrhages are rarely reported but could be a lethal cause of lower gastrointestinal hemorrhage. Currently, there is no consensus on the management of colonic variceal hemorrhage. Variceal ligation, injection sclerotherapy, transjugular intrahepatic portosystemic shunt placement, and balloon-occluded retrograde transvenous obliteration or a combination of the above therapies have been reported with inconsistent success rates. We advocate considering colonic variceal bleeding as a crucial differential diagnosis of lower gastrointestinal bleeding in cirrhotic patients and initiating time-sensitive, definite operative treatment or combination therapy as soon as possible in colonic variceal patients with life-threatening bleeding events, which are often refractory to conservative treatment.

The Association between Diverticular Rebleeding and Early-Morning Blood Pressure and Surge: A Prospective Observational Trial

Introduction: Colonic diverticular bleeding is the major cause of lower gastrointestinal bleeding. Hypertension is a major risk factor for diverticular rebleeding. Direct evidence of an association between actual 24-h blood pressure (BP) and rebleeding is lacking. Therefore, we analyzed the association between 24-h BP and diverticular rebleeding. Methods: We performed a prospective observational cohort trial involving hospitalized patients with colonic diverticular bleeding. We performed 24-h BP measurements (ambulatory BP monitoring [ABPM]) in the patients. The primary outcome was diverticular rebleeding. We evaluated the 24-h BP difference and the morning and pre-awaking BP surge between rebleeding and non-rebleeding patients. Morning BP surge was defined as early-morning systolic BP minus the lowest night systolic BP >45 mm Hg (highest quartile of morning BP surge). The pre-awaking BP surge was defined as the difference between morning BP and pre-awaking BP. Results: Of 47 patients, 17 were excluded, leaving 30 who underwent ABPM. Of the 30 patients, 4 (13.33%) had rebleeding. The mean 24-h systolic and diastolic BP were 125.05 and 76.19 mm Hg in rebleeding patients and 129.98 and 81.77 mm Hg in non-rebleeding patients, respectively. Systolic BP at 5:00 (difference −23.53 mm Hg, p = 0.031) and 11:30 (difference −31.48 mm Hg, p = 0.006) was significantly lower in rebleeding patients than in non-rebleeding patients. Diastolic BP at 2:30 (difference −17.75 mm Hg, p = 0.023) and 5:00 (difference −16.12 mm Hg, p = 0.043) was significantly lower in rebleeding patients than in non-rebleeding patients. A morning surge was observed in one rebleeding patient and no non-rebleeding patients. The pre-awaking surge was significantly higher in rebleeding patients (28.44 mm Hg) than in non-rebleeding patients (9.30 mm Hg) (p = 0.015). Conclusion: Lower BP in the early-morning and a higher pre-awaking surge were risk factors for diverticular rebleeding. A 24-h ABPM can identify these BP findings and reduce the risk of rebleeding by enabling interventions in patients with diverticular bleeding.

A comparative study of scoring systems that accurately predict the prognosis of lower gastrointestinal bleeding.

Lower gastrointestinal (GI) bleeding can be fatal; therefore, several scoring systems have been developed to predict its prognosis. We compared the mortality predictions and evaluated the usefulness of various scoring systems. The medical records of 3794 patients who visited the emergency department with hematochezia between January 2016 and December 2021 were retrospectively reviewed. We calculated the areas under the receiver operating characteristic curves for 30-day mortality and prolonged hospital stay (≥ 10days) based on the age, blood tests, and comorbidities (ABC); AIMS65; Glasgow-Blatchford; Oakland; Rockall (pre-endoscopy); and SHA2PE scores and compared the predictive accuracy of each score. Data for 963 patients (median age, 69years; males, 54.5%; median hospital stay, 6days) with colonoscopy-confirmed lower GI bleeding were analyzed. The 30-day mortality rate was 3.5%; the most common causes of lower GI bleeding were ischemic colitis and diverticulum bleeding in 19.3% and 19.2% of the cases, respectively. The AIMS65 and ABC scores were superior in predicting 30-day mortality (p < 0.001). The SHA2PE score was the most accurate predictor of prolonged hospital stay (p < 0.001). Through multivariate regression analysis, 30-day mortality was correlated with albumin level ≤ 3.0g/dL, international normalized ratio > 1.5, blood urea nitrogen level ≥ 30mg/dL, and systolic blood pressure (SBP) < 100mmHg. A prolonged hospital stay was correlated with liver cirrhosis, hemoglobin ≤ 10g/dL, albumin level ≤ 3.0g/dL, and SBP < 100mmHg. The recently developed scoring systems accurately predict lower GI bleeding prognosis, and their usefulness in clinical decision-making was confirmed.

Bleeding giant Meckel diverticulum, masquerading as abdominal tuberculosis

Meckel’s diverticulum is the most common congenital anomaly of gastrointestinal(GI) tract. It’s clinical presentation varies with age and overlaps with multiple GI pathologies. We are presenting a case of 18-year old boy presenting with overt lower GI bleeding, suspected to be intestinal tuberculosis based on imaging and Mantoux test. Initially responded to anti-tubercular treatment. However, his symptoms of GI bleed recurred, and repeat computed tomography(CT) scan showed suspicion of small bowel stricture with a dilated bowel loop. Exploration revealed a giant Meckel’s diverticulum which was resected and patient remained asymptomatic in the follow-up for 2 years. Bleeding giant Meckel’s diverticulum is sparingly reported in literature. However, even in tuberculosis endemic countries it showed be suspected as a possible cause of lower GI bleeding in young age group.

Safety and efficacy of a new cold snare technique with clipping for colorectal angioectasia.

Colorectal angioectasia is a major cause of lower gastrointestinal bleeding. Use of antithrombotic agents is expected to increase with aging of the population, and bleeding from angioectasia is an important issue. Although the effectiveness of endoscopic mucosal resection for colorectal angioectasia has been reported, there are no reports of cold snare technique for angioectasia (CSA). From February 2018 to February 2022, the safety of CSA was evaluated at Omori Red Cross Hospital. We investigated the incidence of bleeding (delayed post-polypectomy bleeding (DPPB) and immediate bleeding) after CSA and the incidence of rebleeding requiring repeated endoscopic treatment. During the study period, 106 angioectasias were identified during colonoscopy. We only targeted patients with bloody stools and/or anemia requiring treatment for bleeding from angioectasia. Finally, we included 11 angioectasias in this study. Rates of DPPB and rebleeding after CSA were 0 %. The rate of immediate bleeding during CSA was 27.3 % (3/11). Dilated capillaries could be observed pathologically in nine of 11 lesions (81.8 %). CSA was safe and can be a new treatment option in the future. To confirm our results and verify the long-term safety and efficacy of CSA, further studies are desirable.

10-year trends and inpatient outcomes of gastrointestinal angiodysplasia with bleeding in the United States: National Inpatient Sample, 2011 to 2020

Gastrointestinal angiodysplasia (GIAD) is the presence of aberrant blood vessels in the gastrointestinal (GI) tract that can lead to GI bleeding. There has been an increase in the incidence of GI angiodysplasia, partly due to the availability of better diagnostic techniques. The cecum is known as the most common site for GIAD; therefore, GIAD is considered a frequent cause of lower GI bleeding. Studies have shown an increasing incidence of GIAD in the upper GI tract and jejunum. No population-based studies exist on inpatient outcomes of GIAD-bleeding (GIADB) in recent years, and no prior studies have compared the inpatient outcomes of upper vs lower GIADB. We identified 321,559 weighted hospitalizations and found a 32% increase in GIADB-related hospitalizations from 2011 to 2020. There were more hospitalizations for upper (57.38%) than lower GIADB (42.62%), indicating GIADB is an important cause of upper GI bleeding as well. No statistically significant difference in mortality was found between upper and lower GIADB cohorts; however, lower GIADB was associated with a 0.2-day longer length of stay (95% confidence interval 0.09–0.30, P < 0.001) and $3857 higher mean inpatient cost (95% confidence interval $2422–$5291, P < 0.001).

Disease patterns among Saudi children undergoing colonoscopy for lower gastrointestinal bleeding: Single tertiary care center experience.

: The yield of colonoscopy in cases presenting with lower gastrointestinal bleeding (LGIB) in previously published studies varies according to several factors, including endoscopic skills, histopathological experience, and pattern of colonic pathology in different countries. The local literature is limited to a single small 20-year-old study. Our objective was to provide updated data on the diagnostic yield of colonoscopy in Saudi children with LGIB in Saudi Arabia. : This was a retrospective analysis of pediatric patients (0-14 years of age) who underwent colonoscopy for LGIB at the King Fahad Medical City (KFMC), from 2008 to 2018. LGIB was defined as fresh or dark blood per rectum. : During the study period, 175 children underwent colonoscopy for LGIB (99 males, mean age 7.05 ± 3.81 years), which constituted 53.5% of indications for colonoscopy procedures (n = 327) in our center. The terminal ileum was intubated in 81% of the procedures. Overall, inflammatory bowel disease (IBD) was the most commonly identified cause of LGIB (32% ) followed by colonic lymphonodular hyperplasia (CLNH) in 17% and juvenile polyp and rectal mucosal prolapse syndrome (RMPS), 11% each. On sub-analysis, cow's milk protein allergy (CMPA) and CLNH were the most common causes in infants and toddlers, 35% each; IBD (26.5%) and polyps (22.4%) in young children (2-6 years), and IBD (36%), CLNH (14.9%) and RMPS (14%) in older children (6-14 years). In comparing the IBD to the non-IBD group, IBD patients were older (mean 8.37 vs. 6.46 years, P = 0.002) and more likely to have diarrhea, weight loss, high erythrocyte sedimentation rate, anemia, and hypoalbuminemia (odds ratio 24, 11, 10.7, 6.5, and 4, respectively). Colonoscopy had a sensitivity of 97%, specificity of 100%, positive predictive value of 100%, negative predictive value of 81.4%, and accuracy of 97% in diagnosing LGIB. : Colonoscopy is an effective diagnostic tool in children with LGIB with a high diagnostic yield. Besides IBD, CLNH and RMPS are two other important pathologic entities that need to be considered in a child with LGIB.

Dieulafoy's lesion in the cecal pole diagnosed by video-capsule endoscopy. A rare cause of lower gastrointestinal bleeding.

Dieulafoy's lesion is a rare vascular malformation that can cause massive acute gastrointestinal hemorrhage threatening the patient's life. This correspondence to the editor outlines the clinical presentation of a patient in whom, owing to the utilization of capsule endoscopy followed by subsequent colonoscopy, a diagnosis of hemorrhage resulting from a Dieulafoy's lesion located in the colon, a relatively uncommon site, was successfully established. Following intervention involving the application of hemoclips, the patient experienced a favorable clinical evolution.

Causes and Outcome of Children with Lower Gastrointestinal Bleeding (LGIB) Presenting at Tertiary Care Hospital

Background: One of the most potentially fatal pediatric events is gastrointestinal (GI) bleeding. Lower gastrointestinal bleeding children often have anemia, but determining the cause of the bleeding is crucial in developing a management plan. Objective: To assess the causes and outcome of children presenting with lower gastrointestinal bleeding. Methodology: The current study was prospective cross sectional study carried out at the pediatrics department of Fauji Foundation Hospital, Peshawar Cantt for duration of one year from June 2021 to July 2022. A total of 250 children with lower GI bleeding were enrolled in the current study. All the data was analyzed by IBM SPSS version 23. Results: In the current study, male children were 140 (56%) while female children were 110 (44%) with the mean age of 6.80 (± 1.50) years. The commonest complaint was abdominal pain in 105 (42%) patients whereas the commonest clinical observation was pallor observed amongst 115 (46%) patients. Juvenile colonic or rectal polyps were observed in 91 (36.4%) patients based on colonoscopy. Based on histo-pathological findings, polyps were observed in 93 (37.2%) patients, amongst whom 90 (96.77%) cases were Juvenile polyps and 3 (3.33%) cases were familial adenomatous polyposis. Conclusion: There are several underlying causes of lower gastrointestinal bleeding (LGIB). Abdominal pain was a common symptom in children with LGIB while the most typical cause of LGIB in children was a juvenile polyp in our study. Colonoscopy is a safe and effective diagnostic and therapeutic technique for children with LGIB. Keywords: Children; Lower gastrointestinal bleeding; Causes; Outcomes

Acute Colonic Variceal Bleeding in a Cirrhotic Patient Treated by Modified Balloon-occluded Retrograde Transvenous Obliteration: A Case Report

AbstractColonic varices are an uncommon type of ectopic varices that can occur due to underlying liver cirrhosis and portal hypertension. They form a very rare cause of lower gastrointestinal bleeding that can result in massive hemorrhage. We present a 38-year-old woman with a background of ulcerative colitis complicated by primary sclerosing cholangitis-induced liver cirrhosis presenting with fresh rectal bleeding. The colonoscopy failed to identify the source of bleeding. Then, computed tomography scan showed multiple dilated tortuous venous collaterals around the descending colon that extended into the colonic submucosa and drained via the left ovarian vein representing colonic varices. She underwent balloon-occluded retrograde transvenous obliteration (BRTO), which successfully embolized these varices with no significant complications. Despite there being no established management guidelines for colonic variceal bleeding, BRTO is a minimally invasive procedure that can be considered as good option for the treatment of these varices, especially when other alternatives are not applicable.

Utility of colonoscopy in detection of early lower gastrointestinal bleeding at a tertiary care hospital.

Objective: To determine the prevalence of the common causes of lower gastrointestinal bleeding by Colonoscopy as a diagnostic modality in patients with gastrointestinal bleeding. Study Design: Cross Sectional Descriptive study. Setting: Department of Gastroenterology, Liaquat University of Medical and Health Sciences, Jamshoro. Period: March 2021 to August 2021. Material &amp; Methods: This study was performed in Liaquat University of Medical and Health Sciences, Jamshoro in patients presenting with lower gastrointestinal bleeding. History, examination and investigations were carried out. After stabilizing the patient lower gastrointestinal endoscopy was performed. Results: Total 139 patients were included in this study. Intermittent bleeding per rectum was the main presenting complaint followed by continuous bleeding per rectum. The average age of the patients was 45.61 ±16.40 years. Out of 139 patients, 94(67.6%) males and 45(32.4%) females. Bleeding related to internal hemorrhoids was present in 40(28.8 %) patients 30(21.6%) male and 10(7.2%) females as the most common cause of lower GI bleed followed by rectal ulcers 14(10.1%) and polyps in 9(6.5%) patients. infective colitis, proctitis and colonic ulcers were noted in 8(5.8%), 6(4.3%) and 5(3.6%) patients respectively. Malignant lesions in colon and rectum were noted in 8(5.8%) and 3(2.2%) patients while ulcerative colitis, crhon’s and diverticular disease were noted in 5(3.6%), 1(1.4%), 2(0.7%) patients respectively. 29(%) had normal clonoscopic examination. Conclusion: In our population hemorrhoid bleed is the leading cause of lower gastrointestinal bleeding followed by bleeding due to rectal ulcer and polyps.

Our Experience with Patients That Diagnosed Ischemic Colitis in Colonoscopy

Aim: Ischemic colitis (IC) is one of the most common causes of lower gastrointestinal bleeding, especially in patients over 60 years of age. In this study, we investigated the clinical and demographic characteristics of patients with IC detected by colonoscopy. Material and Method: This study was conducted retrospectively by examining the patient records of patients who underwent colonoscopy for various reasons between January 2014 and December 2017. Patients with IC pre-diagnosis in the colonoscopy reports were included in the study. A total of 130 patients were found, 18 patients were excluded from the study due to lack of data and the study was conducted with 112 patients. Results: Definitive IC was diagnosed in 56 of 112 patients who had a preliminary diagnosis of colonoscopy (50%). The average age of patients diagnosed with definitive IC was 68, of which 30 were male and 26 were female. It was observed that IC patients applied to the hospital with complaints of abdominal pain, hematochezia, diarrhea and fever. It is observed that ischemic colitis is most frequently affects left colon. In the doppler findings of patients with IC, all mesenteric vessels and aorta were normal in the vast majority of patients (70%). When predisposing factors that may cause IC were examined, hypertension was observed in 59% of patients, coronary artery disease in 59%, diabetes mellitus in 21% and heart failure in 18%. The vast majority of patients improved with medical therapy (89%). Six patients were given surgery for colon resection (11%), 4 of these patients recovered, but two patients became exitus due to the common thromboembolic condition and associated extensive ischemia (4%). Conclusion: IC is a disease that presents symptoms such as bloody diarrhea and abdominal pain, especially in elderly male patients with predisposing risk factors, frequently seen in the left colon and responds well to medical treatment, and should be considered in every patient with acute diarrhea and abdominal pain.

An Unusual Case of Rectal Bleed in an Section Adolescent: Solitary Rectal Ulcer Syndrome Mimicking Rectosigmoid Malignancy

Solitary Rectal Ulcer Syndrome (SRUS) is an uncommon rectal disorder. Severe rectal bleeding, anaemia and a mass on evaluation are a rare presentation of SRUS, and can pose as an endoscopic challenge in differentiating from other causes of rectal bleeding. The incidence of SRUS is 1 in 100,000 people per year. Hence, a high degree of suspicion and timely diagnosis is necessary. The present case case is about a 17-year-old female who presented with rectal bleeding. Physical evaluation revealed a large polypoidal rectal mass mimicking malignancy which later turned out to be SRUS. The patient improved with medical management. On outpatient follow-up, she had no complaints after a month and follow-up lower endoscopy and imaging later revealed complete healing within three months. Although uncommon, SRUS should be considered as a potential cause of lower gastrointestinal bleeding after sinister causes have been ruled out.

Acute Lower Gastrointestinal Bleeding in an Emergency Department and Performance of the SHA2PE Score: A Retrospective Observational Study.

Lower gastrointestinal bleeding (LGIB) is a frequent cause of emergency department (ED) consultation, leading to investigations but rarely to urgent therapeutic interventions. The SHA2PE score aims to predict the risk of hospital-based intervention, but has never been externally validated. The aim of our single-center retrospective study was to describe patients consulting our ED for LGIB and to test the validity of the SHA2PE score. We included 251 adult patients who consulted in 2017 for hematochezia of <24 h duration; 53% were male, and the median age was 54 years. The most frequent cause of LGIB was unknown (38%), followed by diverticular disease and hemorrhoids (14%); 20% had an intervention. Compared with the no-intervention group, the intervention group was 26.5 years older, had more frequent bleeding in the ED (47% vs. 8%) and more frequent hypotension (8.2% vs. 1.1%), more often received antiplatelet drugs (43% vs. 18%) and anticoagulation therapy (28% vs. 9.5%), more often had a hemoglobin level of <10.5 g/dl (49% vs. 6.2%) on admission, and had greater in-hospital mortality (8.2% vs. 0.5%) (all p < 0.05). The interventions included transfusion (65%), endoscopic hemostasis (47%), embolization (8.2%), and surgery (4%). The SHA2PE score predicted an intervention with sensitivity of 71% (95% confidence interval: 66–83%), specificity of 81% (74–86%), and positive and negative predictive values of 53% (40–65%) and 90% (84–95%), respectively. SHA2PE performance was inferior to that in the original study, with a 1 in 10 chance of erroneously discharging a patient for outpatient intervention. Larger prospective validation studies are needed before the SHA2PE score can be recommended to guide LGIB patient management in the ED.