MELENA (syn.: Tarry stools) - unformed black tarry feces with a fetid odor; characteristic sign of esophageal, gastric, or intestinal bleeding. It may also occur in connection with blood ingestion, such as with nose or pulmonary hemorrhage. Even moderate bleeding (50 - 100 ml) cause the black color of feces, without manifesting itself in any subjective disorders. With more heavy bleeding melena manifests itself after 30 minutes - 2 hours and is accompanied by symptoms of acute blood loss.
Black tarry color feces due to the presence in it of sulfur iron, formed in the intestine as a result of the interaction of hemoglobin and hydrogen sulfide. After taking certain medications (activated carbon, iron preparations, bismuth), feces may also acquire a dark color, but at the same time, the feces are usually normally decorated and do not have a lacquer gloss. The main method of detecting melena is the examination of feces of the patient. If this is not possible, but there is anamnestic information about the tarry nature of feces in the previous stool, as well as if there are other symptoms of internal bleeding (skin paleness, collapse, decrease in hemoglobin in the blood, etc.), rectal examination with feces collected from rectum. This study should also be carried out 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 a violation of blood coagulation processes. At the same time, hemorrhages from the umbilical wound, hemorrhages in the skin and conjunctiva, hematemesis , etc. are observed simultaneously. the nose.
In older children, melena is one of the main, and often the only, symptom of Meckel’s bleeding diverticulum. While bleeding can be massive and lead to severe anemia .
When melena is detected, the patient should be urgently referred to a surgical hospital. Prior to hospitalization, he is denied food intake; only cold water is allowed to drink in small sips; on the stomach, it is advisable to put an ice pack. An in-hospital emergency endoscopic examination is performed (esophagogastroduodenoscopy, colonoscopy), which in most cases makes it possible to establish the source of the bleeding and also to carry out measures aimed at stopping it.