Lower gastrointestinal (GI) haemorrhage - adults and children
This section summarises the emergency assessment, likely causes, investigations, early resuscitation and disposition decisions for lower GI bleeding (LGIB) in adults and children. Emphasis is on rapid recognition of life‑threatening haemorrhage, practical ED decision‑making (who to admit, who may be discharged) and the principal diagnostic and definitive interventions used to localise and control bleeding.
Definition and clinical importance
Lower GI bleeding originates distal to the ligament of Treitz (distal small bowel, colon, rectum or anus). It commonly presents as fresh blood per rectum (haematochezia) or maroon stools. Melaena or blood on nasogastric aspiration suggests an upper GI source; consider early OGD when the origin is unclear.
Acute LGIB ranges from minor self‑limited bleeding to massive haemorrhage with haemodynamic collapse. The immediate ED priority is identification and treatment of haemodynamic instability and timely escalation (major haemorrhage pathway, interventional radiology, endoscopy or surgery).
Common causes (adults and children)
Etiology varies with age.
- Adults: diverticular bleeding (common, often painless), ischaemic colitis, inflammatory bowel disease (ulcerative colitis, Crohn’s), infective colitis, benign anorectal disease (haemorrhoids, fissures, prolapse), angiodysplasia, colorectal neoplasia, post‑procedural bleeding.
- Children: anal fissures, juvenile polyps, Meckel’s diverticulum (classically painless, large‑volume bleeding), intussusception‑related red‑currant jelly stools, infectious colitis and inflammatory bowel disease.
Always consider recent procedures, anticoagulant/antiplatelet therapy and radiation or ischaemic insults as contributors.