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Lower gastrointestinal bleeding (LGIB) is a common problem that can be treated via a number of endoscopic, radiological and surgical approaches. Although traditionally managed by the colorectal surgeons, surgery should be considered a last resort given the variety of endoscopic and radiological approaches available. This article provides an overview on the common causes of acute LGIB and the various techniques at our disposal to control it.

Tender lumps in the inguinal region are often explored emergently to treat suspected hernial strangulation. We discuss the case of an adult male who presented acutely with a tender inguinal swelling and raised inflammatory markers and was therefore deemed as requiring surgical exploration. However preoperative abdominal computerized tomography (CT) revealed an extensive thrombosing congenital venous malformation of portosystemic origin with extension into the symptomatic inguinal canal. A potentially lethal exsanguination from surgery was thus avoided.

An 83-year-old male presented to the emergency department with a history of heavy rectal blood loss. He described copious amounts of fresh blood with multiple clots. There was no previous history of colonic bleeding or prior colonic investigation. Past medical history included atrial fibrillation for which he was on warfarin. On examination he was haemodynamically unstable with a pulse rate of 100 bpm and blood pressure of 104/50 mm Hg. Haemoglobin was 8.6 g/dl and international normalised ratio (INR) was 3. He was immediately resuscitated with packed red cells and fresh frozen plasma. Colonoscopy was not possible as the rate of bleeding and the fact …