Management of acute lower gastrointestinal bleeding

The purpose of this mini-review is to summarize the management of Lower Gastrointestinal Bleeding (LGIB). This entity represents approximately 20% of all cases of gastrointestinal bleeds. The annual incidence is estimated to be between 20 and 27 cases per 100,000 populations, but this data is observed to be increased 200-fold in the elderly. This pathology is mainly self-limited and has a relatively low mortality rate (2-4%). The initial management includes investigate about the form of presentation, color and characteristics of the hemorrhage, the age of the patient, presence of coagulopathy, disease or cardiovascular risk factors, use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), antiaggregants or anticoagulants, previous episodes of hemorrhage, pelvic radiotherapy, endoscopy, polypectomy or previous surgery, change of the recent intestinal rhythm, etc. However, this process must not delay the initiation of hemodynamic resuscitation in patients with patients with ongoing bleeding. Diagnosis is realized through endscopy, which has diagnostic rates of 74% to 100%, or radiographic imaging techniques. The last one includes Computed Tomographic [CT] angiography and radionuclide technetium-99m–labeled red-cell scintigraphy. Both techniques allow definitive treatment. In fact, CT angiography is highly accurate at localizing the site of bleeding (nearly 100%), and can be used immediately before angiography treatment. Definitive treatment may be realized during the diagnosis via endoscopic therapies as well as angiography. If both of them fail, surgical treatment is indicated preferring segmental resections compared to subtotal colectomy