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Acute lower intestinal bleedingPart II: Etiology, therapy, and outcomes

      Table 1Hierarchy of diagnostic certainty for acute colonic bleeding*
      Level I: Definitive diagnosis
       A: Actively bleeding lesion found at endoscopy (anoscopy, sigmoidoscopy, or colonoscopy) or angiography
       B: Stigmata of recent bleeding (nonbleeding visible vessel, adherent clot) found at endoscopy
       C: Positive tagged red blood cell (TRBC) scan if verified by IA or IB
      Level II: Presumptive diagnosis/circumstantial evidence
       A: Fresh blood localized to colon segment inhabited by potential bleeding source
       B: Positive TRBC scan localizing to the colon and colonoscopy that shows potential bleeding site in area of positive scan
       C: Bright red blood per rectum confirmed by objective color testing and colonoscopy that demonstrates single potential bleeding source in colon, complemented by negative upper endoscopy
      Level III: Equivocal diagnosis
       A: “Hematochezia” or blood per rectum (without color specification) and colonoscopy that demonstrates 1 or more potential bleeding sources
      *Presurgical evaluation.
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