1. Abdul-WAHID M Salih
Dept. of surgery / School of Medicine
University of Sulaimani.

2. Lower GI Hemorrhage
Dr.AbdulWAHID M Salih

3. 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

5. Bleeding diverticulosis
Colonic angiodysplasia

6. 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.

7. 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

8. 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.

9. 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.

10. 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.

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

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

14. Diagnostics * Colonoscopy * Video capsule endoscopy
* Intraoperative endoscopy

15. Selective viseral angiography
* Need >0.5 ml/min bleeding
* 40-75% sensitive if bleeding at time of exam

16. Tagged RBC scan
Can detect bleeding at 0.1 ml/min

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

18. Enteroclysis
* Ulcerations
* Inflammation

19. CT scan
* Tumors
* Inflammation
* Diverticuli

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

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

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

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

24. ?

25. THANKS