What should be done to reduce morbidity and mortality once the source of lower gastrointestinal (GI) bleeding (LGIB) has been determined?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Answer

Once the bleeding is determined to be from the lower GI tract as opposed to an upper GI source, the tempo of the bleeding and the extent of blood loss should be quickly estimated so that a precise and targeted algorithm is adopted (see an example in the image below). Patients with massive LGIB usually present with bright red blood per rectum, hypotension, and a markedly reduced hematocrit in contrast to patients with mild bleeding who may present with intermittent passage of maroon stools. The emergency implementation of aggressive resuscitation, diagnostic evaluation, and early involvement of a gastroenterologist (and surgeon in the case of a rapid LGIB) is key to reducing morbidity and mortality and to improving outcomes.

Algorithm for massive lower gastrointestinal (GI) Algorithm for massive lower gastrointestinal (GI) bleeding, surgical perspective. EGD = esophagogastroduodenoscopy; NG = nasogastric; 99mTc RBC = technetium-99m pertechnetate–labeled autologous RBC.

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