INTRODUCTION
Gastrointestinal bleeding, responsible for 612,000 hospital days and $1.2 billion in aggregate health care expenditures in 2009,1 is a common clinical problem encountered by general surgeons. Hospitalization for gastrointestinal bleeding increased 22% between 2000 to 2009,1 likely a consequence of an increasing elderly population and proliferating anticoagulant usage. Hematochezia or melena are frequent clinical impetus for patients to seek evaluation. Although not definitive for localization, their presence in the absence of hematemesis raises the suspicion of lower gastrointestinal bleeding (LGIB), defined as gastrointestinal bleeding with a source distal to the ligament of Treitz. LGIB is associated with colonic sources, such as diverticulosis or angiodysplasia, but can include small bowel sources. LGIB outcomes are more favorable than upper gastrointestinal bleeding (UGIB) and 80% resolve spontaneously.2 Less invasive efficacious interventions likely contributed to the decline in mortality and morbidity over the preceding 20 years.
