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Case 101: Massive bleeding per rectum

A 73 year old man presents via ambulance after collapsing at home. He has been passing large amounts of blood per rectum. He is currently haemodynamically stable after 1000ml IV saline. The nurse looking after him brings you a pan to inspect.

Malaena

1. Where do you think this blood is originating and what are the common causes?

2. How would you investigate this man to determine the source of bleeding?

3. When would you operate on this man?