Although many bleeding lesions in the lower gastrointestinal tract are either self-limited or intermittent, they often lead to considerable losses of blood, and earliest attention must be given to replenishing circulating volume. Diagnostic procedures should be undertaken only after adequate intravenous access has been established and vital signs stabilized. Patients with lower bowel hemorrhage rarely show true melena. Rather, intestinal contents show different shades of red—bright if from the lower third of the colon, and darker and more fetid if more proximal.

The program of diagnosis of lower gastrointestinal hemorrhage is summarized in Fig 1.

Fig. 1 Program of diagnosis of lower gastrointestinal hemorrhage.

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