Melena is the most common presenting symptom of major gastrointestinal hemorrhage. About 90% of quantitatively important gastrointestinal bleeding episodes occur from sites above the ligament of Treitz. Melena usually means bleeding from this location. Melena usually occurs as a result of an upper gastrointestinal bleed (rarely it can be due to bleeding in the small intestine or ascending colon). Upper GI haemorrhage has a number of causes, the most common of which are peptic ulcer disease, liver disease, and gastric cancer.