The Surgical Edge
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Please follow the latest medical or surgical guidelines, local hospital and trust policies for real life practice. These contents are not clinical advice in any way or form and are completely for educational purposes.
The Surgical Edge
Acute Lower GI Bleeding - Management and Risk Stratification
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In the management of acute lower gastrointestinal bleeding (LGIB), CT angiography (CTA) is preferred over colonoscopy in the following specific clinical scenarios:
Haemodynamic Instability: CTA is recommended for patients who remain haemodynamically unstable or have a shock index >1 (heart rate divided by systolic blood pressure) after initial resuscitation.
Ongoing Active Bleeding: It is the preferred initial investigation when there is suspected ongoing, active bleeding, such as the continued passage of large clots or a rising transfusion requirement.
Brisk Bleeding: CTA is indicated when bleeding is too brisk to allow for a safe colonoscopy or when the severity of the hemorrhage makes bowel preparation unfeasible.
Failed Colonoscopy: If a prior colonoscopy has failed to identify or treat the source of the bleeding, CTA is used as the next diagnostic step to localise the site.
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DISCLAIMER: This content is for reference only and you must follow local/standard guidelines in clinical practice
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