Hematochezia causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S. Alberto Plate [2]

Overview

In adults, the most common causes are hemorrhoids and diverticulosis, both of which are relatively benign; however, it can also be caused by colorectal cancer. In a newborn infant (neonate), hematochezia may be the result of swallowed maternal blood at the time of delivery, but can also be an initial symptom of necrotizing enterocolitis, a serious condition affecting premature infants. In adolescents and young adults, inflammatory bowel disease, particularly ulcerative colitis, is a serious cause of hematochezia that must be considered and excluded.

Hematochezia can be due to upper gastrointestinal bleeding. However, as the blood from such a bleeding is usually chemically modified by action of acid and enzymes, it presents more commonly as melena.

Causes

Common Causes

The lower part of the GI tract will usually cause maroon or bright red, bloody stools due to:

• Anal fissures
• Bowel ischemia (when blood supply is cut off to part of the intestines)
• Colon polyps or colon cancer
• Diverticulosis (abnormal pouches in the colon)
• Hemorrhoids (common cause)
• Inflammatory bowel disease (such as Crohn's disease or ulcerative colitis)
• Intestinal infection (such as bacterial enterocolitis)
• Small bowel tumor
• Trauma or foreign body
• Vascular malformation (abnormal collections of blood vessels called arteriovenous malformations or AVMs)

Causes by Organ System

Cardiovascular	Arteriovenous malformations , Bowel ischemia, Bowel strangulation, Cholesterol embolism, Degos disease, Esophageal varices, Hemorrhoids , Hepatic arterioportal fistula, Hereditary haemorrhagic telangiectasia, Idiopathic colonic varices, Leukocytoclastic angiitis, Microscopic polyangiitis, Oesophageal varices, Portal hypertension, Ruptured esophageal varices, Superior mesenteric artery occlusion, Vascular malformation, Vasculitis
Chemical/Poisoning	Arsenicals, Brown snake poisoning , Ethylene glycol, Mercury
Dental	No underlying causes
Dermatologic	Henoch-schönlein purpura
Drug Side Effect	Alosetron, Bevacizumab, Clopidogrel, Cobimetinib, Colchicine, Dicoumarol, Doxorubicin hydrochloride, Hydroxocobalamin, Indomethacin, Melarsoprol, Phenprocoumon, Phenylbutazone, Warfarin, Ziv-aflibercept
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Angiodysplasia, Angiostrongyliasis, Bacillary dysentery, Bacterial enterocolitis, Blue rubber bleb nevus syndrome, Bowel ischemia, Bowel strangulation, Colon polyps , Colonic diverticulitis, Colonic diverticulosis, Colonic tubular adenomata, Colonic villous adenomata, Colonoscopy, Colorectal cancer, Crohn's disease, Dieulafoy's ulcer, Diverticulitis, Diverticulosis, Familial adenomatous polyposis, Gardner's syndrome, Gastric antral vascular ectasia, Gastric cancer, Gastric volvulus, Gastroduodenal ulcers, Hemorrhoids , Idiopathic colonic varices, Inflammatory bowel disease , Inflammatory myoglandular polyp, Intususception of intestine, Mallory-weiss syndrome, Meckel diverticulitis, Necrotizing enterocolitis, Oesophageal cancer, Oesophageal foreign body, Oesophageal varices, Peptic ulcer, Peutz-jeghers syndrome, Pneumatosis cystoides intestinalis, Polypectomy, Portal hypertension, Proctitis, Proctosigmoidoscopy, Pseudoxanthoma elasticum recessive type 1, Pseudoxanthoma elasticum, Rectal cancer, Rectal foreign body, Rectal gastric mucosa heterotopia, Ruptured esophageal varices, Salmonellosis, Sigmoid colon cancer, Small bowel lymphoma, Small bowel tumor, Solitary rectal ulcer syndrome, Staphylococcal food poisoning, Strongyloidiasis, Trichuriasis, Ulcerative colitis, Ulcerative proctitis, Upper gastrointestinal bleeding, Vascular malformation, Vasculitis, Watermelon stomach
Genetic	Craniomandibular dermatodysostosis, Ehlers-danlos syndrome, Endometriosis, Familial adenomatous polyposis, Hereditary haemorrhagic telangiectasia, Meckel diverticulitis, Peutz-jeghers syndrome, Pseudoxanthoma elasticum recessive type 1, Pseudoxanthoma elasticum, Wiskott-aldrich syndrome
Hematologic	Angiodysplasia, Blue rubber bleb nevus syndrome, Clopidogrel, Coagulation disorders, Gastric antral vascular ectasia, Leukocytoclastic angiitis, Upper gastrointestinal bleeding, Warfarin, Watermelon stomach, Wiskott-aldrich syndrome
Iatrogenic	Colonoscopy, Intususception of intestine, Polypectomy, Proctosigmoidoscopy
Infectious Disease	Acanthocephaliasis, Ancylostoma ceylanicum, Ancylostoma duodenale, Angiostrongyliasis, Bacillary dysentery, Bacterial enterocolitis, Balantidiasis, Colitis cystica profunda, Colitis, Entamoeba histolytica, Esophageal cyst, Inflammatory bowel disease , Leptospirosis, Necator americanus , Necrotizing enterocolitis, Salmonellosis, Schistosoma mansoni, Shigella, Staphylococcal food poisoning, Strongyloidiasis, Trichuriasis, Typhoid fever, Ulcerative colitis, Ulcerative proctitis
Musculoskeletal/Orthopedic	Pelvic fracture,
Neurologic	Labrune syndrome, Neurofibromatosis type 1
Nutritional/Metabolic	Carbamoylphosphate synthetase deficiency, Iron compounds, Zinc
Obstetric/Gynecologic	Endometriosis,
Oncologic	Anal cancer, Colon polyps , Colorectal cancer, Gardner's syndrome, Gastric cancer, Inflammatory myoglandular polyp, Kaposi's sarcoma, Labrune syndrome, Oesophageal cancer, Rectal cancer, Sigmoid colon cancer, Small bowel lymphoma, Small bowel tumor
Ophthalmologic	No underlying causes
Overdose/Toxicity	Anthrax, Arsenic trioxide
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Renal failure
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	Anal fissure, Foreign body, Intense exercise, Mallory-weiss syndrome, Oesophageal foreign body, Pelvic fracture, Rectal foreign body, Rectal gastric mucosa heterotopia
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Acanthocephaliasis
• Alosetron
• Anal cancer
• Anal fissure
• Ancylostoma ceylanicum
• Ancylostoma duodenale
• Angiodysplasia
• Angiostrongyliasis
• Anthrax
• Arsenic trioxide
• Arsenicals
• Arteriovenous malformations
• Bacillary dysentery
• Bacterial enterocolitis
• Balantidiasis
• Bevacizumab
• Blue rubber bleb nevus syndrome
• Bowel ischemia
• Bowel strangulation
• Bowel ischemia 
• Brown snake poisoning
• Carbamoylphosphate synthetase deficiency
• Cholesterol embolism
• Clopidogrel
• Coagulation disorders
• Coats plus syndrome
• Cobimetinib
• Colchicine
• Colitis
• Colitis cystica profunda
• Colon polyps 
• Colonic diverticulitis
• Colonic diverticulosis
• Colonic tubular adenomata
• Colonic villous adenomata
• Colonoscopy
• Colorectal cancer
• Craniomandibular dermatodysostosis
• Crohn's disease
• Degos disease
• Dicoumarol
• Dieulafoy's ulcer
• Diverticulitis
• Diverticulosis
• Doxorubicin hydrochloride
• Ehlers-danlos syndrome
• Endometriosis
• Entamoeba histolytica
• Esophageal cyst
• Esophageal varices
• Ethylene glycol
• Familial adenomatous polyposis
• Foreign body
• Gardner's syndrome
• Gastric antral vascular ectasia
• Gastric cancer
• Gastric volvulus
• Gastroduodenal ulcers
• Hemorrhoids 
• Henoch-schönlein purpura
• Hepatic arterioportal fistula
• Hereditary haemorrhagic telangiectasia
• Hydroxocobalamin
• Idiopathic colonic varices
• Indomethacin
• Inflammatory bowel disease 
• Inflammatory myoglandular polyp
• Intense exercise
• Intususception of intestine
• Iron compounds
• Kaposi's sarcoma
• Labrune syndrome
• Leptospirosis
• Leukocytoclastic angiitis
• Mallory-weiss syndrome
• Meckel diverticulitis
• Melarsoprol
• Mercury
• Microscopic polyangiitis
• Necator americanus
• Necrotizing enterocolitis
• Neurofibromatosis type 1
• Oesophageal cancer
• Oesophageal foreign body
• Oesophageal varices
• Pelvic fracture
• Peptic ulcer
• Peutz-jeghers syndrome
• Phenprocoumon
• Phenylbutazone
• Pneumatosis cystoides intestinalis
• Polypectomy
• Portal hypertension
• Proctitis
• Proctosigmoidoscopy
• Pseudoxanthoma elasticum
• Pseudoxanthoma elasticum recessive type 1
• Rectal cancer
• Rectal foreign body
• Rectal gastric mucosa heterotopia
• Renal failure
• Ruptured esophageal varices
• Salmonellosis
• Schistosoma mansoni
• Shigella
• Sigmoid colon cancer
• Small bowel lymphoma
• Small bowel tumor
• Solitary rectal ulcer syndrome
• Staphylococcal food poisoning
• Strongyloidiasis
• Superior mesenteric artery occlusion
• Trauma 
• Trichuriasis
• Typhoid fever
• Ulcerative colitis
• Ulcerative proctitis
• Upper gastrointestinal bleeding
• Vascular malformation
• Vasculitis
• Warfarin
• Watermelon stomach
• Wiskott-aldrich syndrome
• Zinc
• Ziv-aflibercept