Gastrointestinal hemorrhage: is the surgeon obsolete?

Gastrointestinal (GI) hemorrhage has been a scourge of physicians and surgeons for 100 years or more. For much of this time, the site and pathology of the hemorrhage had to be inferred on clinical grounds. Medical treatment was limited to the temporary support of the patient until the bleeding stopped spontaneously or could be controlled by surgical intervention. Before the development of easy intravenous (IV) access and blood transfusion, death from hypovolemic shock was common. In more recent times, new diagnostic methods and treatment modalities have transformed the way in which GI hemorrhage is managed. The modern management of GI hemorrhage spans the fields of emergency medicine, gastroenterology, interventional radiology, and surgery. Three major categories of GI hemorrhage dominate all discussions of management: esophageal varices, nonvariceal upper GI (UGI) bleeding, and lower GI bleeding. A small group of patients will present with evidence of GI blood loss but the source is hard to determine and the cause does not fit neatly into one of the above categories. This review discusses these categories.