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MELENA

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MELENA

Melena is feces or stool marked by black, tarry appearance and a foul odor usually associated with upper gastrointestinal bleeding.

  • The black color and offensive odor are caused by hemoglobin in the blood being altered and degraded by digestive enzymes and intestinal bacteria.
  • Melena is termed a serious medical emergency as it occurs as a result of a significant amount of bleeding.

CAUSES

Melena is caused by bleeding in the upper gastrointestinal tract. This may be due to:

  • Peptic ulcers, this is the most common cause of melena
  • Cancer affecting the esophagus, stomach or small intestine
  • Hemorrhagic blood diseases such as thrombocytopenia and hemophilia
  • Mallory-Weiss syndrome
  • Gastric or esophageal varices
  • Gastritis
  • Vascular malformations
  • Meckel’s diverticulum
  • A less serious case of melena can occur in newborns few days after delivery, due to swallowed maternal blood.

Black coloration of stool can be caused by some other factors that are not due to underlying disease, this should be distinguished from melena. This may include:

  • Medications such as bismuth subsalicylate
  • Foods such as blueberries, beet, or black licorice/liquorice
  • Iron supplements
  • Blood swallowed as a result of a nose bleed
  • Use of medicines such as NSAIDs, aspirin, or blood thinner

SYMPTOMS

Melena is not an actual condition on its own, it is the symptoms of gastrointestinal bleeding.

In cases where a large amount of blood is lost, the patient may have anemia or low blood pressure

DIAGNOSIS AND TREATMENT

To make a diagnosis, the doctor will ask about your symptoms. The doctor will ask you to state when you first spotted your dark stool, your past medical record, any recent illness, if you recently took NSAIDs, aspirin or iron tablets and in what quantity, if you recently ate food such as blueberries, beets, or black licorice/liquorice and in what quantity.

Diagnostic tests will be used to confirm if there is blood in your stool or feces.

  • Blood test
  • A sample of stool may also be tested
  • Esophagogastroduodenoscopy (EGD), where a small attached with a camera and light is inserted through your mouth and passed down your esophagus. This will help your doctor check for signs of bleeding in the upper GI tract.
  • CT or X-ray pictures may show the source of bleeding. It may show a tear, obstruction or tumor.
TREATMENT

One or more of the following treatment option may be used depending on the source of bleeding.

Endoscopy may be used to treat the cause of the bleeding.  The doctor may use heat to close a tear (endoscopic thermal probe), clip tissue together so that it can heal (endoscopic clips), inject a liquid near the source of bleeding to stop the flow of blood (endoscopic injection), or place small rubber bands around esophageal varices to cut off their blood supply, allowing them to dry up and fall off (band litigation).

Blood transfusion may be needed if you have lost a lot of blood.

Surgery may be required if other treatments do not work. Surgery may be needed to fix a tear, or remove tumors.

Black discoloration that occurs as a result of other factors not related to bleeding in the GI tract does not require any treatment.