Lower gastrointestinal bleeding - Distal to Treitz ligament

Lower gastrointestinal bleeding (LGIB) is considered to be all bleeding from the gastrointestinal tract comprised between the duodenum and anus (distal to the ligament of Treitz).

The causes can be grouped together into several categories: anatomical (diverticulosis), vascular (angiodysplasia), ischemia (intestinal infarction), or induced by radiotherapy, inflammatory (inflammatory bowel disease or intestinal infection), neoplastic (polyps or tumors of the colon) and iatrogenic (treatment with anticoagulants).

The main symptom is bloody stools. If there is substantial bleeding, it can be presented in the form of tarry stools, as fresh blood mixed with stools, or as pure blood visible in the toilet.

A detailed medical history, full physical examination and additional tests (laboratory tests, colonoscopy and CT-scan) are required for diagnosis.

The initial treatment goal is resuscitation and maintenance of the vital signs (hemodynamic stability), maintaining proper hydration and correction of anemia by a blood transfusion, if necessary. The cause must be treated through colonoscopy, angiography or through surgery in the most severe cases.