November 28, 2015
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Blood in the Stool (Rectal Bleeding) (cont.)

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Video capsule and small intestine enteroscopy

If neither an upper or lower gastrointestinal source of blood in the stool is found, the small intestine becomes suspect as the source of the bleeding. There are two ways of examining the small intestine. The first is the video capsule, a large pill containing a miniature camera, battery and transmitter that is swallowed and relays photos of the small intestine wirelessly to a recorder carried over the abdomen. The second way to examine the small intestine is with a specialized endoscope similar to the endoscopes used for upper gastrointestinal endoscopy and colonoscopy. The advantage of these endoscopes over the video capsule is that bleeding lesions can be biopsied and treated something that can't be done with the capsule. Unfortunately, small intestinal enteroscopy is time consuming and not generally available. Patients often must be sent to centers where small intestinal enteroscopy is available.

MRI and CT tomographic angiography

Magnetic resonance imaging (MRI) and CT scan can both be used in a manner similar to X-rays in visceral angiography, a diagnostic procedure that has been discussed previously. The use of MRI and CT angiography for diagnosis in gastrointestinal bleeding is a relatively recent development, and their value has not been clearly defined. They could be considered experimental.

Nasogastric tube aspiration

If there is concern about bleeding coming from the stomach or duodenum, nasogastric tube aspiration can be done. A thin, flexible rubber or plastic tube is passed through the nose and into the stomach. The liquid contents of the stomach then are aspirated and examined for visible blood. (The contents also can be tested for occult blood.) If the bleeding is coming from the stomach, there may be visible blood in the aspirate. There also may be visible blood if the bleeding is coming from the duodenum if some of the blood leaks retrograde back into the stomach. The main difficulty in interpreting results of aspiration is that there may be no blood if the bleeding has stopped even temporarily. Therefore, the absence of blood in the aspirate cannot completely exclude the stomach as the source of the bleeding. Only esophagogastroduodenoscopy can exclude causes of upper gastrointestinal bleeding.


If there is major concern about bleeding coming from the esophagus, stomach or duodenum, an esophagogastricduodenoscopy (EGD) can be done using an endoscope similar to the endoscope used for colonoscopy.

Blood tests

Blood tests such as a complete blood count (CBC) and iron levels in the blood play no role in locating the site of gastrointestinal bleeding; however, the CBC and blood iron levels may help to determine whether bleeding is acute or chronic, since an anemia (low red blood cell count) associated with iron deficiency suggests chronic bleeding over many weeks or months. Colonic conditions commonly causing iron deficiency anemia include colon polyps, colon cancers, colon angiodysplasias, and chronic colitis.

When a patient loses a large amount of blood suddenly, as with moderate or severe acute rectal bleeding, the lost blood is replaced by fluid from the body's tissues. This influx of fluid dilutes the blood and leads to anemia (a reduced concentration of red blood cells). It takes time, however, for the tissue fluid to replace the lost blood within the blood vessels. Therefore, soon after a sudden episode of major bleeding, there may be no anemia. It takes many hours and even a day or more for the anemia to develop while tissue fluid slowly dilutes the blood. For this reason, a red blood cell count early after bleeding is not reliable for estimating the severity of the bleeding.

Medically Reviewed by a Doctor on 10/29/2015


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