| [ Summary ] |
Gastrointestinal bleeding is a common condition seen in routine medical practice. When we encounter patients complaining of hematomesis and/or melena, as well as hematochezia, we must examine their vital signs and must insert an indwelling catheter into a blood vessel at the outset. If the patient has been judged to be in hemorrhagic shock, we should gather all relevant medical staff members and treat unstable conditions using blood transfusion and/or vasopressors. Furthermore, we must obtain medical information about the patient. It is very risky to perform endoscopies on patients in unstable general conditions. After adequate informed consent is obtained, we should perform emergent endoscopy to diagnose the cause of bleeding and to carry out endoscopic hemosatic procedures. We should choose the most suitable procedure such as multidetector CT scans, interventional radiology, capsule endoscopy, or balloon enteroscopy. Surgical procedures should be carried out according to the patient's medical condition and the facilities available in the institution. This should be done in the following situations : 1. bleeding point has not been detected, 2. endoscopic hematosatic procedures are not successful,or 3. when thought that hemorrhagic lesions might be encountered in exiting the jejunum or ileum. The mostimportant matter is not stopping the bleeding skillfully,but saving the life of the patient. |