Chinese Medical Journal 2003,2(7):1-3
Li Chujun Li Guohua Hu Pinjin
[Keywords] lower gastrointestinal tract "mass bleeding/causes" major bleeding/diagnosis
Clinical Diagnosis of Massive Lower Gastrointestinal Hemorrhage LI Chu-jun, LI Guo-hua, HU Pin-jin. Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
【Abstract】Aims To study the causes and diagnostic methods of the massive lower gastrointestinal hemorrhage. Methods Clinical analysis of 45 cases of massive lower gastrointestinal hemorrhage in regard to etiology, bleeding site and manifestation. All the cases were confirmed by colonoscopy, operation or/ and pathological assessment. Results The results demonstrate that the tumor and the polyp comprise the majority of the causes of the massive lower gastrointestinal hemorrhage (37.8%, 17/45), with malignancy being predominant (76.5%, 13/17). All of the malignant tumor and the polyp are located in large intestine. The inflammatory diseases rank second (24.4%, 11/45), followed by the structure disorders of the intestinal wall (17.8%, 8/45), angiopathy (11.1%, 5 /45) and anal disease (8.9%, 4/45). Many of the patients are adult (88.9%, 40/45). Most of the inflammatory disease patients are youth (81.8%, 9/11) and all malignant tumors occurred in elder patients. The majority of the diseases located in large intestine (71.1%, 32/45) that include tumor, polyp, ulcerative colitis, diverticulum and hemorrhoids. The small intestinal diseases (28.9, 13/45) mainly comprise inflammatory diseases, Meckel diverticulum and hemangioma. The dramatic presentation of bleeding is hematochezia (93.3%,42/45), the other 3 cases of the diseases located in small intestine presented as melena. None of patients accompanied by hematemesis. Those with abdominal pains, tenderness of the abdomen or emaciation mostly suffer from tumor or inflammatory disorder of the intestine, and fever mainly occurred in the inflammatory intestinal disorder. Conclusions Most of the disorders that induced massive lower gastrointestinal hemorrhage are the large intestinal diseases and many of them are tumor. Hematochezia is the dramatic manifestation of bleeding. Urgent colonoscopy in an opportune moment is the most effective first test to detect the cause and the site of the bleeding and it can provide the therapeutic opportunity under endoscopy to stop bleeding in some patients. Angiography, radionuclide scanning, wireless endoscopy or small bowel endoscopy might promote diagnostic accuracy in some small intestinal disorders.
【Key words】lower gastrointestinal tract; massive hemorrhage/etiology; massive hemorrhage/diagnosis