Lower GI bleed — CTA localisation and embolisation viva

Priority diagnosis and CTA. Acute massive LGIB with right-colon active extravasation — severe LGIB → CTA localises and enables IR; do not delay embolisation for colonoscopy in the unstable patient.^[1]

Therapy. Resuscitate with restrictive transfusion per local LGIB protocol; reverse anticoagulation per guideline; proceed to superselective embolisation (pooled technical success 97.0%, rebleed 20.7%, ischaemia 7.5%; post-2010 rebleed 18.6%, ischaemia 7.3%).^[5] Failed embolisation → surgery. HDU/ICU.

Pitfalls. UGIB drugs; over-transfusion; attributing massive bleed to haemorrhoids; delaying IR for a "definitive colonoscopy diagnosis" — CTA-positive patients have a defined management role per guideline.^[1]