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Acute Lower Gastrointestinal Bleeding, Management of2018

Type: New Practice Management Guideline (PMG)
Category: Emergency General Surgery
Committee Liaison: Nicole Fox, MD, MPH, FACS

Team leader(s)

Acute lower GI tract bleeding (LGIB) accounts for more than 300,000 hospital admissions per year in the United States. This condition is associated with high morbidity and mortality, and can be a diagnostic dilemma for both gastroenterologists and acute care surgeons. There are no clear guidelines on the utility and optimal timing
of colonoscopy for acute LGIB, and the role of other localization techniques (such as CT angiography, angiography, radionuclide bleeding scans, provocative mesenteric angiography) in patients with persistent hemodynamic instability and ongoing bleeding after exclusion of an upper GI tract source remains unclear. In terms of operative
management, surgical therapy is typically recommended only when other therapeutic options have failed and after careful localization of the bleeding source. However, in the case of non-localized bleeding, is subtotal colectomy (with or without end ileostomy) versus limited colon resection (based on the most likely source) associated with better
outcomes? Given the lack of consensus on many of these diagnostic and therapeutic interventions, a Practice Management Guideline would help guide decision making surrounding the emergency management of massive or persistent LGIB for the Acute Care Surgeon.

Work Group Members
Nikolay Bugaev, MD
John Como, MD, MPH
Paula Ferrada, MD
Stephen Gondek, MD, MPH
Eric Legome, MD
Amy McDonald, MD
Nimitt Patel, MD
Jaswin Sawhney, MD
Brian Williams, MD
D. Dante Yeh, MD

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Eastern Association for the Surgery of Trauma

633 N. Saint Clair Street, Suite 2400 Chicago, IL 60611-3295 (312) 202-5508 phone (312) 202-5064 fax managementoffice@east.org
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