Bleeding from Lower GI Tract

Haemorrhage originating distal to the ligament of Treitz, usually presenting as fresh blood per rectum or melaena (black, tarry stools).

• Diverticular Disease: Most common in Western countries.

• Angiodysplasia: Abnormal blood vessels in the colon.

• Colorectal Cancer: Especially if advanced.

• Inflammatory bowel disease.

• Anorectal sources: Haemorrhoids, fissures.

• Ischaemic colitis.

• Meckel’s diverticulum (though often considered upper GI).

• History & Examination: To assess severity and potential sources.

• Laboratory tests: Full blood count, coagulation profile, renal function.

• Colonoscopy: First-line, allows for direct visualisation and potential therapeutic intervention.

• CT Angiography: Useful if rapid bleeding (>0.5 mL/min).

• Tagged Red Blood Cell Scan: For slower bleeds.

• Flexible sigmoidoscopy: In patients unfit for full colonoscopy.

• Resuscitation First: IV fluids, blood transfusion, cross-match blood.

• For ongoing or recurrent bleeding not amenable to endoscopic control:
  

• • Segmental colectomy if source identified.
  • Total/subtotal colectomy if source not identified or multiple sites.

• Preoperative Localisation: CT angiography or tagged RBC scan may help localise bleed.

• Laparoscopic vs Open: Approach decided based on patient stability, surgeon expertise, and suspected pathology.

• Monitor vital signs and haemoglobin levels.

• Ensure adequate pain relief.

• Early mobilisation to prevent thromboembolic events.

• Consider prophylactic antibiotics if large bowel surgery performed.

• Resuscitation is the first step in management of significant lower GI bleed.

• Colonoscopy remains the mainstay of both diagnosis and therapeutic intervention.

• Surgery is reserved for those with ongoing or recurrent bleeding not controlled by endoscopic means or if a resectable pathology is identified (e.g., cancer).