Massive lower digestive bleeding

Lower digestive bleeding is the bleeding distal to the ligament of Treitz and ranges from occult loss to massive hemorrhage. Acute and massive form represents about 20% of all gastrointestinal acute bleeding. In children and young patients the most frequent causes are juvenile, polyps Meckel diverticula, and intussusception; in adult ages are the diverticular disease of colon, angiodysplasia and neoplasia; we must include also the intestinal TBC, typhoid fever, and intestinal amebiasis. The first aim in the management of this acute syndrome is the treatment of the hypovolemic shock; when the patient is well resuscitated, the diagnosis of the cause of hemorrhage will start using the clinical history and physical examination, proctosigmoidoscopy, emergency colonoscopy and/or angiography, or scintigraphy with 99mTc-labeled red blood cells. Definitive therapy include endoscopic an angiographic methods, or the emergency surgery. Mortality is 11% to 21%.