Acute lower gastrointestinal bleeding: SUMMARY
Lower gastrointestinal bleeding remains a difficult diagnostic and therapeutic problem. Most patients have lower gastrointestinal bleeding that stops spontaneously. These patients can be investigated by colonoscopy over the 24 to 48 h following a standard colonic preparation. For the 15% of patients whose bleeding continues, identification of the bleeding site is critical for subsequent management. Colonoscopy should be performed on an urgent basis by experienced endoscopists who are skilled in the management of coagulation techniques. With this approach, most patients can be triaged to endoscopic therapy or operative therapy accordingly with a low morbidity and mortality as well as low incidence of rebleeding. Bleeding sites demonstrated on nuclear scans (if used) should be confirmed by angiography before surgical intervention because of the poor localization capabilities of nuclear scans of the bowel. Unfortunately, good randomized studies in the assessment of lower gastrointestinal bleeding are not available. However, retrospective and prospective case series seem to indicate that, in appropriate hands, emergency colonoscopy can be safe and sensitive. Because colonoscopy also offers a therapeutic role (in addition to a diagnostic one), whenever possible, it should be the investigative method of choice for lower gastrointestinal hemorrhage. Fast and reliable shopping for drugs – to get safe shopping atmosphere.