MELENA

MELENA (syn: tarry stool) - unformed black tar-like feces with fetid odor; A characteristic sign of esophageal, gastric or intestinal bleeding. It can also be observed in connection with swallowing of blood, for example, with nasal or pulmonary hemorrhage. Even moderate bleeding (50 - 100 ml) causes black color of the bowel movements, not showing any expressed subjective disorders. With more abundant bleeding, melena appears after 30 minutes - 2 hours and is accompanied by symptoms of acute blood loss.

The black tar color of the stool is due to the presence of sulphurous iron formed in the intestine as a result of the interaction of hemoglobin and hydrogen sulphide. After taking some medications (activated charcoal, iron preparations, bismuth), stools can also acquire a dark color, but the stool, as a rule, is normally decorated and does not have a lacquered luster. The main method for detecting melena is to examine the patient's feces. If this is not possible, but there is anamnestic information about the degenerative nature of the stool in the preceding stool, and also in the presence of other symptoms of internal bleeding (pallor of the skin, collapse, decrease in hemoglobin in the blood, etc.), a rectal examination with examination of feces collected from the walls Rectum. This study should also be conducted in sudden fainting states of unknown origin.

Newborns distinguish between true and false melena. True melena can appear already in the first days after birth due to violation of blood coagulation processes. At the same time, hemorrhages from the umbilical wound, hemorrhages to the skin and conjunctiva, bloody vomiting , etc. are simultaneously observed. False melena can be caused by swallowing of the mother's blood during childbirth and in the process of breast sucking at nipple cracks, as well as own blood in case of damage to the oral mucosa and Nose.

In children of an older age, melena is one of the main, and often the only symptom of the bleeding diverticula of Meckel. In this case, bleeding can be massive and lead to severe anemia .

When detecting melena, the patient should be urgently sent to a surgical hospital. Prior to hospitalization, he is prohibited from eating; Drink only cold water in small sips; It is advisable to put a bubble with ice on the stomach. In the hospital, an emergency endoscopic examination (esophagogastroduodenoscopy, colonoscopy) is performed, which allows in most cases to establish the source of bleeding, as well as to carry out activities aimed at stopping it.