Melena Detected in Rectal Examination

CLINICAL DIAGNOSTIC MANUAL

Melena, or the presence of black, tarry stool detected during a rectal examination, is a clinical sign indicating bleeding in the upper gastrointestinal tract.

This bleeding typically originates from lesions above the ligament of Treitz, as the blood is digested while passing through the intestines, giving it the characteristic black color. Melena is an alarming sign and requires urgent diagnostic evaluation to determine the underlying cause and guide appropriate treatment.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Bleeding Duodenal Ulcer	Epigastric pain, melena, hematemesis	Clinical history, vital signs, physical examination	Upper gastrointestinal endoscopy, complete blood count (CBC)
Bleeding Gastric Ulcer	Epigastric pain, melena, hematemesis	Clinical history, vital signs, physical examination	Upper gastrointestinal endoscopy, CBC
Gastric Erosion	Epigastric pain, melena	Clinical history, vital signs, physical examination	Upper gastrointestinal endoscopy, CBC
Esophageal Varices	Massive hematemesis, melena, signs of liver failure	Clinical history, history of cirrhosis, physical examination	Upper gastrointestinal endoscopy, CBC, liver function tests
Mallory-Weiss Syndrome	Hematemesis following violent vomiting, melena	History of vomiting, physical examination	Upper gastrointestinal endoscopy
Esophageal Carcinoma	Dysphagia, weight loss, hematemesis, melena	Clinical history, physical examination	Upper gastrointestinal endoscopy with biopsy, CT scan, MRI
Gastric Carcinoma	Weight loss, anorexia, epigastric pain, melena	Clinical history, physical examination	Upper gastrointestinal endoscopy with biopsy, CT scan, MRI
Gastroesophageal Reflux Disease (GERD)	Heartburn, acid regurgitation, chest pain, melena	Clinical history, physical examination	Upper gastrointestinal endoscopy, esophageal pH monitoring
Hiatal Hernia	Heartburn, regurgitation, epigastric pain, melena	Clinical history, physical examination	Upper gastrointestinal endoscopy, esophagogram
Corrosive Ingestion	Chest or abdominal pain, dysphagia, hematemesis, melena	History of ingestion, physical examination	Upper gastrointestinal endoscopy, esophagogram
Meckel’s Diverticulum	Abdominal pain, melena, anemia	Clinical history, vital signs, physical examination	Technetium-99m scan, laparoscopy
False Hematemesis	Presence of blood in vomit or melena without evidence of gastrointestinal source	Clinical history, physical examination	Exclude non-gastrointestinal sources, upper gastrointestinal endoscopy if gastrointestinal source suspected
Hemorrhagic Diathesis	Easy bleeding, bruising, melena	Clinical history, physical examination	Coagulation studies, CBC, specific platelet function and coagulation factor tests
Other Causes	Symptoms vary depending on the underlying condition	Clinical history, vital signs, physical examination	Specific tests based on clinical suspicion