Perdarahan saluran

cerna bawah
(Hematokezia)

Nella Suhuyanly

Passage of blood or clots from rectum

Originating distal of ligamentum Treitz

May be associated with:

Annal causes in healthy young adult (< 50 yo.)

Colorectal cancer (few cases)

Incidence

Colon 95-97%
Small bowel 3-5%
9-15% of healthy young adults
10 - 15% of massive GI bleeding
Up to 42% have multiple sites

LGI hemorrhage

Etiology

Diverticulosis 40-55%

Angiodysplasia 3-20%

15% of UC patients, 1% of chrons patients

Radiation, infectious, AIDS rarely

Vascular
Hemorrhoids

Typically bleed slowly

Inflammatory conditions

Most common cause of SB bleeding in >50 y/o

>50% are in right colon

Neoplasia

Right sided lesions > left

90% stop spontaneously
10% rebleed in 1st year and 25% at 4 years

Others

>50% have hemorrhoids, but only 2% of bleeding attributed to them

Colonic angiodysplasia
Bleeding
diverticulosis

LGI hemorrhage diagnostics

Colonoscopy

Selective viseral angiography

Within 12 hours in stable patients without large

amounts of bleeding
Need >0.5 ml/min bleeding
40-75% sensitive if bleeding at time of exam

Tagged RBC scan

Can detect bleeding at 0.1 ml/min

85% sensitive if bleeding at time of exam
Not accurate in defining left vs right colon

Meckels Diverticulum

Cecal angiodysplasia
with extravasation

Small bowel ulceration

due to NSAIDS

LGI hemorrhage treatment

Endoscopy

Angiographic

Great for angiodysplasia and polypectomy sites

Selective embolization for poor surgical candidates
Can lead to ischemic sites requiring later resection

Surgery

Ongoing hemorrhage, >6 units or ongoing transfusion

requirement
Site selection
Blind segmental will rebleed in 75%
Based on TRBC scan will rebleed in 35%

Treatment

Surgery

Without localization only for acute exsanguinating

hemorrhage
Intraoperative endoscopy
Segmental resection

THANK YOU