Melena

The passage of black, tarry, foul-smelling stools containing digested blood, typically indicating upper gastrointestinal hemorrhage from bleeding proximal to the ligament of Treitz, most commonly involving the esophagus, stomach, or duodenum.

Causes

• Gastric causes

  • Peptic ulcer disease

  • Gastritis

  • Gastric erosions

  • Gastric polyps

  • Gastric tumors

  • Dieulafoy's lesion

  • Gastric cancer/polyp

• Esophageal causes

  • Esophageal varices

  • Esophagitis

  • Mallory–Weiss tear

  • Esophageal cancer/polyp

• Medication-related causes

  • NSAIDs

  • Aspirin

  • Anticoagulants

  • Antiplatelet medications

  • Corticosteroids (risk factors for ulcer disease)

• Swallowed blood causes

  • Severe nosebleed (epistaxis)

  • Hemoptysis

  • Oral or upper airway bleeding