Algorithm for the management of severe hematochezia modified according to patient's history
Algorithm for the management of severe hematochezia modified according to patient's history Acute Lower Gastrointestinal Bleeding Acute Lower Gastrointestinal Bleeding
«Flowchart»

Severe hematochezia

Severe hematochezia

Severe hematochezia

<Node Text>

<Node Text>

<Node Text>

<Node Text>

<Go to node 3>

<Go to node 3>

<Go to node 3> Node 3

<Go to node 4>

<Go to node 4>

<Go to node 4> Node 4

<End Node 3>

<End Node 3>

<End Node 3>

<End Node 3>

<End Node 4>

<End Node 4>

<End Node 4>

<End Node 4>

Ongoing hemodynamic resuscitation

Ongoing hemodynamic resuscitation

Ongoing hemodynamic resuscitation

History, physical examination, NG tube

History, physical examination, NG tube

History, physical examination, NG tube

Colonic purge and urgent colonoscopy

Colonic purge and urgent colonoscopy

Colonic purge and urgent colonoscopy

Anoscopy and flexible sigmoidoscopy

Anoscopy and flexible sigmoidoscopy

Anoscopy and flexible sigmoidoscopy

EGD and/or
push enteroscopy

EGD and/or
push enteroscopy

EGD and/or
push enteroscopy


End

End

End

No source identified: Push enteroscopy

No source identified: Push enteroscopy

No source identified

Source identified: Treat

Source identified: Treat

Source identified: Treat

End

End

End

Source identified: Treat

Source identified: Treat

Source identified: Treat

No source identified:
Capsule endoscopy or
RBC scintigraphy or angiography

No source identified:
Capsule endoscopy or
RBC scintigraphy or angiography



No source identified

End

End

End

End

End

End

History of cirrhosis, ulcers,
melena, or hematemesis

History of cirrhosis, ulcers,
melena, or hematemesis


History of cirrhosis

History of hemorrhoids,
pelvic or abdominal
radiation, colitis, diarrhea

History of hemorrhoids,
pelvic or abdominal
radiation, colitis, diarrhea



History of hemorrhoids

No identifiable risk factors,
painless hematochezia

No identifiable risk factors,
painless hematochezia


No identifiable risk factors

End

End

End

Source identified: Treat

Source identified: Treat

Source

No source identifed

No source identifed

No source

End

End

End

Source identified: Treat

Source identified: Treat

Source identified: Treat

No source identified

No source identified

No source identified

Deep enteroscopy includes double-balloon enteroscopy, single-balloon enteroscopy, and spiral enteroscopy. (From Feldman M et al: Sleisenger and Fordtran’s gastrointestinal and liver disease, ed 11, Philadelphia, 2021, Elsevier.)

Deep enteroscopy includes double-balloon enteroscopy, single-balloon enteroscopy, and spiral enteroscopy. (From Feldman M et al: Sleisenger and Fordtran’s gastrointestinal and liver disease, ed 11, Philadelphia, 2021, Elsevier.)

Deep enteroscopy includes double-balloon enteroscopy, single-balloon enteroscopy, and spiral enteroscopy. (From Feldman M et al: Sleisenger and Fordtran’s gastrointestinal and liver disease, ed 11, Philadelphia, 2021, Elsevier.)

Source identified: Treat
(may require deep enteroscopy*)

Source identified: Treat
(may require deep enteroscopy*)


* * Source identified: Treat

No source identified:
Deep enteroscopy* or surgery

No source identified:
Deep enteroscopy* or surgery


* * No source identified