GI tract invasion of non-GI tract malignancy.Meckel's diverticulum (in adults less often than children).Dieulafoy's lesion of small or large bowel.Ischaemic colitis (mesenteric vascular insufficiency).Massive upper gastrointestinal (GI) bleeding.Arteriovenous malformation (angiodysplasia).It should, however, not be forgotten that nearly one third of rectal cancer patients are younger than 55 years of age. For those over the age of 50, there should be a higher suspicion of colorectal cancer. Those under the age of 30 presenting with rectal bleeding are more likely to have haemorrhoids, an anal fissure or inflammatory bowel disease. The age of the patient gives a clue to aetiology and as a result forms a part of referral guidelines (see below). However, it is essential to understand the aetiology, as this shapes the investigations, management and ultimately the likely outcome. Studies have differing results according to population demographics, patient selection, size of study and other confounding factors. It is difficult to obtain accurate figures for the relative frequency of the different causes of rectal bleeding. In particular the cause to be excluded is colorectal cancer. However, there are many other possible causes, some of which are sinister.
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