Hematochezia

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Classification according to ICD-10
K92.1 Melena
K62.5 Hemorrhage of the anus and rectum
ICD-10 online (WHO version 2019)

Haematochezia (also blood stool or rectal bleeding ) is a form of gastrointestinal bleeding with the appearance of fresh blood in the stool . A distinction must be made between haematochezia and the excretion of blood that has already changed color in tarry stools ( melena ).

causes

Bleeding usually originates in the lower gastrointestinal tract. Massive upper gastrointestinal bleeding, e.g. B. gastric bleeding , however, can also lead to blood stool, so that the physical condition of the patient is the most important differential diagnostic sign for the level of the bleeding source. Fresh blood may appear in your stool for many reasons. Hemorrhoids are a common cause of bleeding from the anus . But also anal fissures , fine tears in the anus, can lead to bleeding.

Other possible causes are:

diagnosis

The disease underlying melena requires further clarification. After the questioning and general examination of the patient, an esophagogastroduodenoscopy (gastroscopy) is first performed, since 80–90% of the bleeding is located in the upper digestive tract. If there is a hematochezia, it is advisable to perform a rectal examination in combination with a hemoccult test using the guaiac method and a rectocoloscopy ( colonoscopy ). If the examination remains inconclusive and the histological specimens taken during gastroscopy or colonoscopy are normal, further examinations may be useful depending on the previous findings: MR fistulography (visualization of fistulas by means of contrast medium magnetic resonance of the colon), (CT) Angiography of the abdominal vessels to rule out intestinal ischemia (emergency examination), clarification of haemophilia (tendency to bleed). A reliable statement about the location of the bleeding cannot be made based on the appearance of the stool. A rough rule of thumb is that the further the bleeding source is located orally (towards the mouth), the stool tends to appear black (so-called melena ), while aborally (towards the anal) bleeding sources tend to cause red blood discharge (so-called hematochezia ). On the other hand, however, it is the case that large bleeding in the upper gastrointestinal tract can also lead to hematochezia, and distal (distant) sources of bleeding can also lead to melena due to the fermentation of intestinal bacteria.

therapy

Treatment for rectal bleeding varies from case to case and is based on the cause of the bleeding. In the case of bleeding in the upper gastrointestinal tract (esophagus, stomach, duodenum ), for example, (depending on the underlying cause), an injection with vasoconstrictor substances, the application of a clip , an APC laser coagulation , a sclerotherapy or a ligature can be performed endoscopically during the gastroscopy . In a serious emergency situation , one can try medication to stop the bleeding with terlipressin or sandostatin . If the above options fail, there is also the option of balloon tamponade ( Sengstaken probe or Linton-Nachlas probe ) if there is life-threatening bleeding in the upper gastrointestinal tract .

If the bleeding is located in the lower gastrointestinal tract, appropriate therapy can be used. If hemorrhoids are the cause of hematochezia, various therapy options can be considered.

Web links

Individual evidence

  1. ↑ Alphabetical index for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 342