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Perdarahan saluran

cerna bawah
(Hematokezia)

Nella Suhuyanly

Passage of blood or clots from rectum


Originating distal of ligamentum Treitz

May be associated with:

Annal causes in healthy young adult (< 50 yo.)


Colorectal cancer (few cases)

Incidence

Colon 95-97%
Small bowel 3-5%
9-15% of healthy young adults
10 - 15% of massive GI bleeding
Up to 42% have multiple sites

LGI hemorrhage

Etiology

Diverticulosis 40-55%

Angiodysplasia 3-20%

15% of UC patients, 1% of chrons patients


Radiation, infectious, AIDS rarely

Vascular
Hemorrhoids

Typically bleed slowly

Inflammatory conditions

Most common cause of SB bleeding in >50 y/o


>50% are in right colon

Neoplasia

Right sided lesions > left


90% stop spontaneously
10% rebleed in 1st year and 25% at 4 years

Others

>50% have hemorrhoids, but only 2% of bleeding attributed to them

Colonic angiodysplasia
Bleeding
diverticulosis

LGI hemorrhage diagnostics

Colonoscopy

Selective viseral angiography

Within 12 hours in stable patients without large


amounts of bleeding
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


85% sensitive if bleeding at time of exam
Not accurate in defining left vs right colon

Meckels Diverticulum

Cecal angiodysplasia
with extravasation

Small bowel ulceration


due to NSAIDS

LGI hemorrhage treatment

Endoscopy

Angiographic

Great for angiodysplasia and polypectomy sites


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

Surgery

Ongoing hemorrhage, >6 units or ongoing transfusion


requirement
Site selection
Blind segmental will rebleed in 75%
Based on TRBC scan will rebleed in 35%

Treatment

Surgery

Without localization only for acute exsanguinating


hemorrhage
Intraoperative endoscopy
Segmental resection

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