Rectal bleeding accounts for approximately 1 out of every 1000 United States emergency department visits annually. The causes of rectal bleeding are broad, and can range from the benign to the life-threating.
Our recent issue Emergency Department Management of Patients With Rectal Bleeding provides foundational knowledge on rectal bleeding as well as evidence-based recommendations for its evaluation and initial management in the emergency department.
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Here are a few key points:
- The severity of rectal bleeding depends on the underlying etiology, which can range from benign and self-limiting to life-threatening.
- The differential diagnosis depends on identification of the cause, based on age, comorbid conditions, duration of symptoms, and anatomic, hematologic, and metabolic derangements.
- Table 1 in the issue outlines causes of rectal bleeding in adults and children. Table 2 lists medications and toxins associated with rectal bleeding, and Table 3 lists rectal bleeding mimics.
- Most bleeding sources in the colon or distal present as hematochezia, and upper GI bleeds (UGIBs) present with hematemesis and/or melena; however, depending on the cause, this may not always be the case.