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Approach to acute lower gastrointestinal bleeding in adults

Lisa Strate, MD, MPH
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Acute lower gastrointestinal (GI) bleeding refers to blood loss of recent onset originating from the colon. The causes of acute lower GI bleeding may be grouped into several categories: anatomic (diverticulosis), vascular (angiodysplasia, ischemic, radiation-induced), inflammatory (infectious, inflammatory bowel disease), and neoplastic. In addition, acute lower GI bleeding can occur after therapeutic interventions such as polypectomy. (See "Etiology of lower gastrointestinal bleeding in adults" and "Bleeding after colonic polypectomy".)

This topic will review the clinical manifestations, diagnosis, and initial management of acute GI bleeding thought to be coming from the colon. The etiology of lower GI bleeding and the treatment of specific causes of bleeding, as well as approaches to patients with upper GI bleeding, minimal rectal bleeding, suspected small bowel bleeding, and occult GI bleeding, are discussed separately. (See "Etiology of lower gastrointestinal bleeding in adults" and "Colonic diverticular bleeding" and "Angiodysplasia of the gastrointestinal tract" and "Bleeding after colonic polypectomy" and "Approach to acute upper gastrointestinal bleeding in adults" and "Approach to minimal bright red blood per rectum in adults" and "Evaluation of suspected small bowel bleeding (formerly obscure gastrointestinal bleeding)" and "Evaluation of occult gastrointestinal bleeding".)


Patients with acute lower gastrointestinal (GI) bleeding typically present with hematochezia, although hematochezia may also be seen in patients with massive upper GI or small bowel bleeding. Rarely, patients with right-sided colonic bleeding will present with melena. The bleeding will stop spontaneously in 80 to 85 percent of patients, and the mortality rate is 2 to 4 percent [1]. (See 'Clinical manifestations' below.)

In patients suspected of having acute lower GI bleeding, the approach to diagnosis and management includes (algorithm 1):

General management, including obtaining adequate intravenous access, triaging the patient to the appropriate level of care, and providing supportive measures such as supplemental oxygen (see 'Initial evaluation and management' below)

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Literature review current through: Nov 2017. | This topic last updated: May 17, 2016.
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