ABSTRACT
The most common classification of gastrointestinal bleeding (GIB) divides the process into two categories based on anatomic site of origin. Upper GI bleeds occur between the mouth and duodenum, and lower GI bleeds (LGIB) start anywhere distal to the ligament of Treitz. This chapter focuses on the subset of LGIBs that are confined to the colon, rectum and anus. Initial resuscitation and evaluation should be performed simultaneously. The resuscitation is aimed at achieving haemodynamic stability, correcting coagulopathies, and establishing intravenous access for ongoing treatment. The role of colonoscopy in the immediate evaluation of severe LGIB continues to evolve. In general it is the best tool for evaluating occult bleeding and small volume, intermittent bleeding. Endoscopic clips are also effective for treating an identified bleeding vessel, diverticulum or previous polypectomy site. They are deployed on the bleeding vessel or to provide compression of tissue around the vessel for tamponade.
