LOWER GASTROINTESTINAL BLEEDING

Abstract

Lower G.I.T. bleeding is a difficult problem which may face the physician at any time either as acute urgent cases or chronic cold cases. Diagnosis and management of bleeding per rectum may require the efforts of internist, radiologist, endoscopist and surgeon working as a team. Bleeding per rectum is not necessarily rectal in origin, but it may originate from anywhere in the gastrointestinal tract from mouth to anus, and usually it indicates bleeding of lower intestinal origin, i.e., from a point below the level of ligament of Treitz.

As regards the aetiology of lower G.I.T. bleeding experiences of many surgeons have been reviewed to evaluate the relative frequency of many diseases involved in its causation. The most common cause is the ano-rectal lesions, e .g . haemorrhoids, anal fissure and rectal varices. Colorectal cancer is also a frequent cause especially in elderly patients. The role of diverticular disease in massive lower gastrointestinal haemorrhage has been postulated. Since using selective angiography for identifying the source of bleeding, there has been increased recognition of bleeding from vascular abnormalities of the colon . Many authors have suggested that angiodysplasia are as important as or even more important than diverticular disease in the causation of lower gastrointestinal bleeding. Other less important causes have been reported as inflammatory bowel diseases, colonic polyps, benign rectal ulcer and small bowel neoplasm. In Egypt, bilharziasis is one of the commonest causes of rectal bleeding.