Intended for healthcare professionals

Practice Rational Imaging

Acute lower gastrointestinal haemorrhage

BMJ 2009; 339 doi: (Published 17 November 2009) Cite this as: BMJ 2009;339:b4156

Haematochezia - look below

Local rectal pathologies are recognised causes of bright red rectal
bleeding with haemodynamic shock [1]. Rectal ulcers, haemorrhoids and most
other anorectal pathologies can be controlled by simple local
interventions. It is both embarassing and negligent to expose patients
to ionising radiation without first excluding anorectal causes by
proctoscopy and sigmoidoscopy. It would be even more deficient to proceed
directly to laporotomy in a patient with bleeding piles[2]. In the absence
of coherent national guidance, the authors of local guidelines should
stress the need to exclude anorectal causes in patients presenting with
haematochezia, regardless of their haemodynamic status

[1] Hotta T, Takifuji K, Tonoda S, Mishima H, Sasaki M,Yukawa H, Mori
K, Fuku A, Yamaue H.
Risk factors and amnagement of massive bleeding of an acute haemorrhagic
rectal ulcer. The American Surgeon. 2009; 75:66-73

[2] Fiddian-Green R J. A radiological death? An on line response
[12/01/10] to Andrew J Edwards and Giles F Maskell
Acute lower gastrointestinal haemorrhage
BMJ 2009; 339

Competing interests:
None declared

Competing interests: No competing interests

15 January 2010
Simon J McPherson
Interventional Radiologist
Leeds teaching Hospital Trust