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CDHB

Lower GI Bleeding

Background

• A lower GI bleed may present with substantial rectal bleeding.
• This should be distinguished from minor outlet rectal bleeding.
• The differential diagnosis can range from angiodysplasia, diverticular disease, polyps, bowel cancer to eating beetroot.
• Bleeding from the lower bowel usually stops spontaneously and management is usually supportive until this occurs. These patients rarely need emergency surgery.

Investigation and Management

• Resuscitate.
• CBC + diff, Na, K, creatinine, LFTs, INR, APTT.
• Assess coagulation history, comorbidities, relevant history, including medications (oral anticoagulants, antiplatelet drugs, NSAIDs etc). Correct as needed.
• If patient stable:
  • Close observation until bleeding stops. Decide on follow-up investigations such as colonoscopy, CT colonography.
• If patient unstable or re-bleeds:
  • CT angiography:
    • If no active bleeding, watch and wait, with possible rescanning if further major bleed.
    • If active bleeding, consider a further angiogram with embolization, or surgery.
  • Colonoscopy. There is a role for colonoscopy, however this is usually when there is a target lesion, i.e., a post polypectomy bleed.
  • Labelled red cell scan. Used selectively when there are repeat bleeds if the cause of bleeding has not been identified by CT angiography.

Topic Code: 66527