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Background Lower gastrointestinal (GI) bleeding frequently recurs after negative technetium 99m–labeled red blood cell (RBC) scintigraphy. Methods Between July 1, 1999 and July 31, 2005, 84 negative 99m Tc-labeled RBC scintigrams were obtained for acute lower GI bleeding. Medical records were abstracted for age, gender, prior history of lower GI hemorrhage, length of hospitalization, initial hematocrit (Hct) and Hct nadir, transfusion requirements, cause of bleeding, use of anticoagulants and/or antiplatelet medications, and rebleeding episodes. Results The overall rate of rebleeding was 27% (n = 23). There were no significant associations between any of the patient variables investigated and rebleeding. Conclusions Despite negative 99m Tc-labeled RBC scintigraphy, more than 25% of patients experience recurrent lower GI bleeding. Patient age, bleeding source, use of anticoagulant/antiplatelet medications, length of stay, admission Hct, Hct nadir, transfusion requirements, and gender are not predictive of the patients who will rebleed.

Malignant and potentially malignant lesions of the anus are rare. A knowledge of anal anatomy aids in understanding the diagnosis, evaluation, and management of these important lesions. While the patient’s symptoms and visual characteristics of the lesion often suggest a diagnosis, a biopsy is frequently necessary for confirmation. The evaluation obtainable during an endoscopic evaluation as well as biopsy techniques are discussed and general treatment options are presented to broaden the endoscopists understanding of definitive management.

Continuous mucosal involvement from the rectum proximally is one of the hallmarks of ulcerative colitis. However, recent pathologic series report appendiceal ulcerative colitis in the presence of a histologically normal cecum, representing a "skip" lesion. The clinical significance of this finding has not been established. Eighty patients, 54 males and 26 females, average age 37.9 years (range 14 to 82 years) who underwent proctocolectomy for ulcerative colitis from January 1990 to September 1995 were examined to determine the rate of discontinuous appendiceal involvement. Excluded were 12 patients with prior appendectomy and 11 with fibrotic obliteration of the appendiceal lumen. Of the remaining 57 patients, seven (12.3%) had clear appendiceal involvement in the presence of a histologically normal cecum. These seven patients clinically were indistinguishable from the 50 patients without skip involvement of the appendix in terms of age at surgery, pretreatment medications, type of surgery, interval from diagnosis to definitive procedure, complications, functional results, and clinical course. Discontinuous appendiceal involvement was found in 12.3% of patients undergoing proctocolectomy for ulcerative colitis, and clinically these patients behave as those without this feature.