Acute lower gastrointestinal bleeding: SPECIFIC CAUSES OF LGI BLEEDING Part 7
Neoplasms: Occult rectal bleeding and the passage of bright red blood per rectum are typical presentations of adenomatous polyps and adenocarcinomas of the colon and rectum. Severe hematochezia, however, is relatively uncommon. Conflicting reports of incidence likely result from referral bias. Rossini et al reported that 32% of patients with massive colonic bleeding had ulcerated carcinomas or polyps, while Jensen and Machicado reported it as a cause in only 11% of patients. The true incidence is likely somewhere in between. Polyps and small cancers are amenable to endoscopic therapy, but most cancers require surgical intervention. Online shopping will cost you less – find and enjoy the experience.
Bleeding is the most common complication after colonoscopic polypectomy. Immediate bleeding (often easily controlled at the time of endoscopy) occurs in up to 3% of cases, delayed polypectomy hemorrhage occurs in up to 0.3%. Treatment of early and late postpolypectomy bleeding is usually endoscopic, with identification of the bleeding stalk being of paramount importance. Grasping the stalk with a snare and recauterizing or simply closing the snare around the stalk for a period of time is usually sufficient to allow a coagulum to form. Other methods of therapy include cauterization and, for patients in whom endoscopic therapy fails, angiographic embolization and surgical resection have been successfully reported. If the bleeding appears to be coming from an induced ulcer postpolypectomy, treatment would include injection of adrenaline and the use of the heater or bipolar probe. Lower power settings and light tamponade are recommended. Neodymium:yttrium-aluminum-garnet laser and monopolar electrocoagulation are not recommended in the treatment of these ulcerations because of the possibility of transmural injury. In the case of delayed hemorrhage, other sites of bleeding must always be considered preoperatively. If there is any doubt regarding the site of bleeding, a complete colonoscopy must be performed.