Lower Gastrointestinal Bleeding Differential Diagnoses

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Diagnostic Considerations

The average age of patients with lower gastrointestinal bleeding (LGIB) is 60 years in most case series. Despite improvement in diagnostic imaging and procedures, 10%-20% of patients with LGBI have no demonstrable bleeding source, and 5%-10% of patients may present with recurrent episodes of massive LGIB without any identification of the bleeding site. These patients often experience multiple hospital admissions; they also undergo recurrent blood transfusions and several invasive studies repeatedly. Therefore, this complex problem requires systematic and orderly evaluation to reduce the percentage of undiagnosed and untreated cases of LGIB.

Differential diagnosis

For common conditions that cause LGIB, see Etiology. Rare causes of LGIB that may need to be considered include the following:

  • Chronic radiation enteritis/proctitis
  • Ischemic colitis/mesenteric vascular insufficiency
  • Colonic/rectal varices
  • Portal colopathy
  • Solitary rectal ulcer syndrome
  • Diversion colitis
  • Vasculitides
  • Small bowel ulceration
  • GI bleeding in runners

Differential Diagnoses