From the Research
Introduction to Melena
Melena is a medical condition characterized by black, tarry stools, typically indicating upper gastrointestinal bleeding [ 1 ]. A 44-year-old patient presenting with melena for three months requires a thorough diagnostic evaluation to determine the underlying cause.
Differential Diagnosis
The differential diagnosis for melena is broad and includes various upper gastrointestinal pathologies, such as:
- Duodenal ulcers
- Gastric ulcers
- Gastritis
- Malignancies, including colon cancer [ 2 ]
- Hemorrhoids, although less common as a cause of melena [ 3 ]
Diagnostic Approach
A comprehensive diagnostic approach should include:
Clinical Evaluation
- Medical history, including previous surgeries, such as Roux-en-Y gastric bypass [ 4 ]
- Physical examination
- Laboratory tests, including complete blood count and blood chemistry
Endoscopic Evaluation
- Upper endoscopy to visualize the upper gastrointestinal tract and identify potential sources of bleeding [ 1 ]
- Colonoscopy to rule out lower gastrointestinal causes, such as colon cancer [ 2 ]
Imaging Studies
- Computed tomography (CT) scans of the chest, abdomen, and pelvis to evaluate for potential malignancies or other pathologies [ 2 ]
Treatment and Management
Treatment and management of melena depend on the underlying cause and may include:
- Medications, such as proton pump inhibitors or histamine-2 blockers, to reduce acid production and promote healing
- Endoscopic therapies, such as injection sclerotherapy or cauterization, to control bleeding
- Surgery, in cases where endoscopic therapy is unsuccessful or not possible
- Chemotherapy and/or radiation therapy, in cases of malignancy [ 2 ]
Caveats and Considerations
- Patients with melena may present with hematochezia, which can indicate a more severe bleeding episode and worse prognosis [ 1 ]
- A thorough diagnostic evaluation is essential to determine the underlying cause of melena and guide appropriate treatment
- Patients with a history of anticoagulation therapy or bleeding disorders may require special consideration and management [ 5 ]