Background: Acute lower GI bleeding (LGIB) is a common clinical situation that needs work up for proper diagnosis and individualized management. Aim of the work: Enlisting causes of acute LGIB in our locality, detecting the relation between causes and severity of the bleeding and compare different available therapeutic options for each case. Patients and Methods: One hundred patients with acute LGIB were included in this study. Patients attended our hospital during period from September 2011 to February2012 were classified according to the risk assessment score into two groups; group I (high risk group) included 39 patients and group II (moderate risk group) included 61 patients. Initial resuscitation and routine laboratory studies were done for all patients, and then procedures for localization of the bleeding site were done utilizing colonoscopy, enteroscopy, mesenteric angiography and radionuclide scintigraphy that were individualized for every patient. Medical, endoscopic, angiographic or surgical treatments were initiated according to the bleedingtype, site and availability of the treatment modality. Results: Our study included 100 patients, 63 males and 37 females. Group I included 39 patients (24 males and 15 females) with age range (24-78 y) and mean ± SD (56.2 ± 14.1 y) and group II included 61 patients (39 males and 22 females) with age range (30-64 years) and mean ± SD (44 ± 15.3 y)). Majority of patients (84.7%) in group I were presented with bright red hematochezia (84.6%), while, majority of patients (70.5%) in group II were presented with a maroon stool. Abdominal tenderness was the most frequent associated symptoms in both groups (74.4 % in group I and 36 % in group II). Requirement of blood units in group I was twice as that of group II. Significant differences were found between the two groups regarding hemoglobin level, hematocrit value, PT, and INR concentration. Rectosigmoid junction and descending colon followed by anorectal area and sigmoid colon (20.5 % vs. 37.7 %, 15.4 % vs.14.7 % and 12.8 % vs.11.5% respectively)were the commonest sites of the bleeding in both groups, moreover, bleeding from ascending colon was found to be more severe than other sites followed by bleeding from small intestine and descending colon. Diverticular disease, angiodysplasia and portal hypertensive colopathy (28.2 %, 12.9 % and 12.9 % respectively) were the main causes of acute LGIB among patients in group I, while, colitis, malignant neoplasm and benign polyps(14.7 %, 13.3 % and 11.5 % respectively) were the main causes of acute LGIB in group II. Colonoscopy was the best and beneficial diagnostic modality in our study; it was able to detect causes of the bleeding in 95% in group I and 91 % of causes in group II. Conservative medical management was successful in stopping bleeding in 18 patients (46.2%) in group I and in 28 patients (49.9%) in group II,while,endoscopic therapy was effective in stopping the bleeding in 15 patients (38.5%) in group I and in 27 patients (44.3%) in group II. Complete recovery was achieved in 71.8% of cases in group I and in 86% in group II. Conclusion: Acute LGIB is a common medical and surgical challenge. Diverticular disease is by far the most common cause of acute LGIB in our study. Medical conservation and endoscopic treatment are successful tools in stopping most cases of acute LGIB.
