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
CSDT writes - "Regardless of the cause, if bleeding recurs after it has once stopped, the chances of success without operation are low. Most patients who rebleed in the hospital should have surgery.
In 85% of patients, bleeding stops within a few hours of admission. About 25% of patients rebleed once bleeding has stopped. Rebleeding episodes are concentrated with the first 2 days of hospitalization, and if the patient has had no further bleeding for a period of 5 days, the chances of rebleeding is only 2%.
Rebleeding is most common in patients with varices, peptic ulcer, anemia or shock.
About 10% of patients require surgery to control bleeding, and most of these patients have bleeding ulcers, or less commonly, esophageal varices. The death rate is 30% among pts who rebleed and 3% among those who do not. The mortality rate is also high in the elderly and in patients who are already hospitalized at the onset of bleeding. Analysis of large series of patients suggests that a number of those who died would not have done so if operations had been performed earlier and more often."
Emergency angiography
Repeat upper GI endoscopy
Enteroscopy
Laprotomy