Chapter 33 - Acute gastrointestinal bleeding and perforation

Summary

The three common forms of presentation for acute gastrointestinal (GI) bleeds are: haematemesis, melaena, and haematochezia. This chapter discusses the complications associated with GI bleeding and management of GI bleeding. It lists the commonest causes of upper GI bleeding, and explains management of non-variceal upper GI bleeding and upper GI bleeding indications for surgery. Gastro-oesophageal varices are dilated submucosal veins which occur in approximately 40-60% of patients with cirrhosis. Control of active variceal bleeding has been shown to be achievable with sclerotherapy (80%) or band ligation (94%). The chapter discusses the incidence of upper GI perforation and lower GI perforation. Approximately 15% of patients with diverticulitis develop bowel perforation. The mortality rate is high (20-40%) as patients may suffer from sepsis and multiorgan failure. The chapter discusses initial management, specific management and post-operative complications of bowel perforation. Endoscopic treatment achieves haemostasis in the majority of patients with non-variceal bleeding.