Question
A patient comes with hematemesis and malena. On the upper GI endoscopy there was no significant finding. 2-days later the patient rebleeds. Next line of investigation is
| A. |
Emergency angiography
|
| B. |
Repeat upper GI endoscopy
|
| C. |
Enteroscopy
|
| D. |
Laparotomy
|
Show Answer
|
Correct Answer » B
Explanation
|
|
Repeat upper GI endoscopy is the next best step
-
- Initial endoscopy may miss lesions due to:
- Poor visualization (blood/clots)
- Intermittent bleeding
- Small lesions (e.g., Dieulafoy lesion)
- Repeat endoscopy has a high diagnostic yield in rebleeding
A. Emergency angiography
- Used when:
- Active ongoing bleeding
- Patient is hemodynamically unstable
- Endoscopy fails repeatedly
- Not first step after just one negative endoscopy
C. Enteroscopy
- Used for small bowel bleeding
- Considered only after:
- Both upper GI endoscopy and colonoscopy are negative
- Not the immediate next step
D. Laparotomy
- Last resort
- Reserved for:
- Uncontrolled bleeding
- Failure of all other modalities
