Lower gastrointestinal bleeding - Distal to the ligament of Treitz

A lower gastrointestinal haemorrhage (LGE) is any bleeding from the gastrointestinal tract between the duodenum and the anus (distal to the ligament of Treitz).

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

The main symptom is bloody stools. If the bleeding is heavy, it may present as blackish tar-like stools, as fresh blood mixed with the stool, or as pure blood visible in the toilet.

Diagnosis requires a detailed clinical history, thorough physical examination and complementary tests (laboratory tests, fibrocolonoscopy and CT-scan).

The initial goal of treatment is the maintenance of vital signs (haemodynamic stability), ensuring proper hydration and if necessary correcting the loss of red blood cells by blood transfusion. The cause should be treated by colonoscopy, angiography or surgery in the most severe cases.