Focal ulcerationFocal ulceration: Focal ulceration with severe hemorrhage is a rare cause of massive LGI bleeding. This ulceration may arise from inflammatory bowel disease or after polypectomy, as discussed above, or from infection or ischemia. It’s time to pay less money – just get at the best online pharmacy.

Typical infections include cytomegalovirus (in immunocompromised patients) and pseudomembranous colitis. These infections are often first suspected at clinical presentation because both are usually accompanied by diarrhea, and are associated with either immune suppression or recent antibiotic exposure. Other infections, such as amebiasis, have occasionally been reported to cause severe gastrointestinal hemorrhage. Treatment is directed at the underlying cause of the bleeding, not necessarily at the bleeding itself. If endoscopic therapy is attempted, it should be performed only after failure of medical treatment. These bleeding lesions can be treated with a combination of adrenaline injection with or without the use of bipolar probe. Extreme caution must be employed because the colonic wall of these lesions is typically thin and easily perforated. Some patients require colectomy for definitive therapy. Cold guillotining-off of adherent clots, as performed in UGI ulcers, has been suggested by Jensen and Machicado for focal colonic ulcers with adherent clots.