CROSSING POINT IN THE MANAGEMENT ALGORITHM OF ACUTE LOWER GASTROINTESTINAL BLEEDING – CASE REPORTS AND LITERATURE REVIEW

Abstract

Acute  lower  gastrointestinal  bleeding  is  a significant  problem, a  rare  and  life  threatening  situation,  that has  a  mortality  rate  situated  between  2  and  4% (1).  According to recent studies up to 15%  of them present as  massive  bleeding  and  5%  require  surgery (2). Acute lower  gastrointestinal  bleeding  can  be  divided  according  to  their  location  in  the  small  or  large  bowel. The  small  intestine  is  less interested  and is known to be  the  commonest  cause  of  obscure  bleeding. About 5%  of  total  lower  gastrointestinal  bleeding  comes from the small intestine (3). When conservative medical treatment associated with  interventional endoscopy can not handle the bleeding, endovascular therapy  can be salutary. Also  in  some  rare  cases  of  acute  lower  gastrointestinal   bleeding  with  hemodynamic  instability  the  last  therapeutic  resource  remains  surgery.  Thus, we will present  two  cases  of  acute  lower  gastrointestinal  bleeding  which  were  managed  different, we will then summarize the  different  variants  of  available  treatment  and  finally, in  the  conclusions, we  will underscore  the  most  important  steps  of  the  management algorithm and highlight the crossing point   in  acute  lower  gastrointestinal  bleeding.