Acute Severe Lower Gastrointestinal Bleeding in Low- and Medium-Income Countries: An Approach to Management of Two Cases and the Need for Local Guidelines.

Acute severe lower gastrointestinal bleeding (LGIB) refers to continued significant bleeding that occurs within the first 24 hours of admission and may be associated with hemodynamic instability. Patients at risk of severe LGIB include elderly patients often with comorbidities and on antiplatelets/anticoagulants. The accepted guidelines and recommendations used in the management of patients with acute severe LGIB are mainly based on research and evidence from high-income countries which may not be practical in low- and middle-income countries (LMICs). The management of these patients in LMICs is often based on more pressing concerns such as availability of relevant equipment, affordability of care, and accessible technical expertise. In LMICs, surgery plays a major role in patients with severe bleeding and hemodynamic instability refractory to resuscitation and blood transfusion. Here, we discuss the management of two patients who presented with acute severe LGIB and the applicability of the current guidelines in the management of LMIC patients.