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"LOWER" GASTROINTESTINAL TRACT HEMORRHAGE: NEW CONCEPTS BASED ON ARTERIOGRAPHY

WILLIAM J. CASARELLA M.D., SHELBY J. GALLOWAY M.D., RICHARD N. TAXIN M.D., DAVID A. FOLLETT M.D., EDWARD J. POLLOCK M.D., and WILLIAM B. SEAMAN M.D.

1. Arteriography is the diagnostic method of choice in acute rectal hemorrhage and results in precise preoperative diagnosis and rational surgery. The potential for selective therapy through the catheter is also evident.

2. Colonic diverticulosis is, by far, the most common cause of acute rectal bleeding in the middle-aged or elderly adult.

3. Most bleeding colonic diverticula are located to the right of the splenic flexure.

4. Carcinoma is a rare cause of rectal hemorrhage.

5. The bleeding point is occasionally located outside of the colon.

6. A history of trauma or previous surgery should suggest the possibility of arteriovenous fistula.

7. Arteriovenous malformations of the right colon should be diligently searched for in elderly patients with aortic stenosis and recurrent hemorrhage.

8. Hemorrhage from duodenal ulcer may present as rectal hemorrhage and lead to diagnostic confusion.


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