Abdul-WAHID M Salih Abdulwahid.salih@univsul.edu.iq Dept. of surgery / School of Medicine University of Sulaimani. www.doctorabdulwahid.com

Lower GI Hemorrhage Dr.AbdulWAHID M Salih

LGI hemorrhage *Intermittent bleeding common Colon (95-97%) Small bowel (3-5%) * Only 15% of massive GI bleeding * Finding the site *Intermittent bleeding common * Up to 42% have multiple sites

Bleeding diverticulosis Colonic angiodysplasia

Diverticulosis – 40-55% * 90% stop * spontaneously * 10% rebleed in 1st year and 25% at 4 years Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.

argon plasma coagulation Angiodysplasia (3-20%) >50 y/o >50% are in right colon Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy. argon plasma coagulation

Neoplasia Typically bleed slowly Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.

Inflammatory conditions 15% of UC patients, 1% of chron’s patients Radiation Infectious AIDS rarely Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.

Hemorrhoids * >50% have hemorrhoids * but only 2% of bleeding attributed to them Others = meckel’s, juvinial polyps, solitary rectal ulcer, Dieulafoy’s lesion of the colon, portal colopathy, NSAIDs, intussusception, or bleeding following colonoscopic biopsy or polypectomy.

Meckels Diverticulum * The most common cause of massive bleeding in pediatric patients

Evaluation * Same for UGI bleed If unstable with hematochezia need EGD 1st

Diagnostics * Colonoscopy * Video capsule endoscopy * Intraoperative endoscopy

Selective viseral angiography * 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

Meckel’s scan Initial test for patients <30 years old

Enteroclysis * Ulcerations * Inflammation

CT scan * Tumors * Inflammation * Diverticuli

GI hemorrhage from unknown source Only 2-5% are not upper or lower

Treatment * Theraputic Endoscopy: * Diagnostic polypectomy sites Angiodysplasia polypectomy sites

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

Surgery * Ongoing hemorrhage, >6 units * Ongoing transfusion requirement Site selection Intraoperative endoscopy Segmental resection

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