Severe bleeding resulting in haemodynamic instability is an unusual complication of acute ulcerative colitis. After excluding the possibility of gastric or duodenal ulcer bleeding, if the patient remains haemodynamically unstable after adequate resuscitation, emergency surgical procedure is indicated. If there is slow but continuing hemorrhage, in a haemodynamically stable patient, an attempt at medical management may be tried for 48-72 h, before proceeding to surgery. A number of studies have proposed clinical prognostic criteria or a predictive model that can forecast risk of recurrent bleeding, need for therapeutic treatment and outcome of patients with massive colonic bleeding [2,18]. However, the main indications for emergency surgery for severe lower intestinal bleeding are hypotension and shock despite resuscitation, continuous bleeding (>6 U of packed red blood cells transfused) and/or recurrent bleeding after 24 h of stability, with additional transfusion and further decrease of hematocrit value.
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