Lower GI bleeding in the elderly. Diverticulosis and angiodysplasia as dominant causes

Angiography has greatly improved the precision of diagnosis of massive lower gastrointestinal bleeding in elderly patients. This, in turn, has permitted a more conservative approach, even when operative management becomes necessary. It bears emphasis, however, that hematochezia in elderly patients is usually relatively benign and tends to cease spontaneously. An overly enthusiastic diagnostic or therapeutic course is not warranted, and conservative control of the acute episode, followed by sufficient evaluation to rule out malignancy, is probably all that is necessary. When massive bleeding becomes persistent or recurrent, however, it is clearly life threatening, and a vigorous diagnostic and therapeutic program should be initiated promptly.