OBSCURE LOWER GASTRO INTESTINAL TRACT BLEEDING

Abstract

Obscure lower G.I.T. bleeding is defined as an acute or chronic loss of blood frmn the rectum, the source of which has not been identified after gastroscopy, clonoscopy, upper and lower gastrointestinal series of investigations. The most common cause for obscure lower G.I.T. bleeding is angiodysplasia, followed by tumours of the small intestine, large intestine, and various other causes, including small bowel ulcers and arteriovenous malformations AVMs. Those with recurrent lower G.l.T. bleeding that is difficult to diagnose should undergo a sequence of investigations ranging from pan­ endoscopy, through small and large bowel, radiological contrast studies, . radio isotope scan, and selective visceral angiography to peropenitive enteroscopy. This sequence should help to identify the site or sites of bleeding before embarking on surgery; if an operation is carried out, it should be as the final diagnostic and therapeutic step. Obscure lower G.lT bleeding after careful endoscopy of the upper and lower tract is predominantly of small bowel origin. Lastly an aggressive approach should be applied m patients in

whom standard evaluation fails to localize the source of bleeding. Endoscopy, laparotomy with per-operative enteroscopy can achieve an excellent yield and allow resection and potential cure.