Pitfalls

It is important to be aware of the following pitfalls when dealing with the assessment and management of lower GI haemorrage:

• Underestimating the severity of bleeding can have dire consequences
• Failure to comprehend that even with treatment there is a relatively high rate of rebleeding
• Forgetting that up to 15% of patients with fresh PR bleeding will have an upper GI source and the cause of bleeding may only be found on an upper GI endoscopy
• Failure to recognise that haemodynamic instability, particularly following initial resuscitation, indicates a high risk patient at risk of significant bleeding and higher complication rates
• Failure to perform a digital rectal examination in patients with a lower GI bleeding (this must be done in all patients)