The term massive melena means the passage of large amounts of blood by rectum, frequently producing shock and a low hemoglobin and red blood cell count. This condition may necessitate several transfusions. Occasionally a patient who has had repeated gastrointestinal studies and exploratory celiotomies which have failed to reveal the source of bleeding comes for treatment of massive melena. This problem has been discussed by others, particular Stone,1 of Baltimore, and such a case has been presented previously from this clinic by Norcross and Cattell.2 In this paper, the problem of obscure massive melena will be reviewed, diagnostic methods evaluated, and a plan of management proposed.
With such patients the immediate treatment consists of restoring the blood volume by repeated transfusions. Another attempt is then made by diagnostic methods to determine the location and nature of the lesion. The physical examination will aid in ruling out any systemic