The most common cause of what initially appears to be lower GI bleeding is actually upper GI bleeding. Thus, proximal etiologies should be sought.
Among patients with an established lower GI source of their bleeding, the most common etiology is hemorrhoids. Among nonhemorrhoidal bleeding, angiodysplasia and diverticular disease are most common, followed by adenomatous polyps and malignancies.4
DIVERTICULOSIS Diverticular bleeding is usually painless and is thought to result from erosion into the penetrating artery of the diverticulum. Diverticular bleeding may be massive. Patients are often elderly with underlying medical illnesses that contribute to both the morbidity and the mortality rates.
ANGIODYSPLASIA Arteriovenous malformations (angiodysplasia), usually of the right colon, are a common etiology of obscure lower GI bleeding, particularly in the elderly population. They are thought to be more common in patients with hypertension and aortic stenosis.
OTHER ETIOLOGIES Numerous other lesions may result in lower GI hemorrhage. Although carcinoma and hemorrhoids are relatively common causes of bleeding, massive hemorrhage is unusual. Similarly, inflammatory bowel disease, polyps, and infectious gastroenteritis rarely cause severe bleeding. Finally, Meckel diverticulum is an unusual but important etiology to keep in mind.
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