GI HEMORRHAGE • SENIOR RESIDENT / SURGEON

GI Bleeding — Upper / Lower

Major GI hemorrhage is a physiology-first problem: stabilize the patient, determine whether the source is upper or lower, localize active bleeding and escalate from endoscopy to angiography or surgery when necessary.

PROTOTYPE REVIEW REQUIRED

The Call

Older adult with brisk GI bleeding and hypotension

Tachycardia, hypotension and ongoing hematemesis or hematochezia with falling hemoglobin.

Hemodynamically unstable

The first decision is resuscitation, not localization; the second is whether the source is upper or lower.

Read the Image • Clinical DataACS VISUAL

Endoscopic bleeding lesion from the ACS image archive.

Make the Decision • Commit to a Plan

A patient with brisk GI bleeding remains hypotensive after initial resuscitation. Upper endoscopy is nondiagnostic and blood continues per rectum. Best next principle?

GI Bleeding — Upper / Lower

Older adult with brisk GI bleeding and hypotension

A patient with brisk GI bleeding remains hypotensive after initial resuscitation. Upper endoscopy is nondiagnostic and blood continues per rectum. Best next principle?

Angiography localizes active right-colonic bleeding but embolization fails and shock persists. Best next step?

After segmental colectomy, brisk hematochezia recurs and hemoglobin falls rapidly. Best next step?

Operate only after the source and physiology are understood as well as circumstances permit.

Rebleeding risk remains after initial control.

Surgical Pearls

Pitfalls

Massive hematochezia continues despite endoscopic therapy, but the source has not been localized. What operative pitfall should be avoided?