CROSSING POINT IN THE MANAGEMENT ALGORITHM OF ACUTE LOWER GASTROINTESTINAL BLEEDING 53 CLINCAL CASE CROSSING POINT IN THE MANAGEMENT ALGORITHM OF ACUTE LOWER GASTROINTESTINAL BLEEDING – CASE REPORTS AND LITERATURE REVIEW G. Andrei 1,2 , B. Dumitriu 1,2 , L. Gulie 3 , F. Bulca 1 , M. Beuran 1,2 1 Department of Surgery, Clinical Emergency Hospital Bucharest, Bucharest, Romania 2 University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania 3 Department of Interventional Radiology, Clinical Emergency Hospital Bucharest, Bucharest, Romania Corresponding author: Bogdan Dumitru Phone no.: +40745085192 E-mail: b_dumitriu@yahoo.com Abstract Acute lower gastrointestinal bleeding (LGIB) is a significant health problem with a quite important mortality rate. It can be located in the small or large bowel. The small intestine is less interested and is known to be the commonest cause of obscure bleeding. When conservative medical treatment associated with interventional endoscopy cannot handle the bleeding, endovascular therapy can be salutary. Also, in some rare cases of acute LGIB with hemodynamic instability the last therapeutic resource remains surgery. Therefore, we will reveal a couple of cases with LGIB, we will review the different variants of treatment and in the conclusions, we will underscore the steps of the management in acute LGIB. Keywords: acute lower gastrointestinal bleeding, management algorithm, crossing point Introduction Acute lower gastrointestinal bleeding (LGIB) is a significant health problem with a quite important mortality rate. It can be located in the small or large bowel. The small intestine is less interested and is known to be the commonest cause of obscure bleeding. When conservative medical treatment associated with interventional endoscopy cannot handle the bleeding, endovascular therapy can be salutary. Also, in some rare cases of acute LGIB with hemodynamic instability the last therapeutic resource remains surgery. Case presentation Case report 1 We present the case of a 29-year-old male patient who was hospitalized in the surgery clinic of Floreasca Emergency Hospital for hematochezia, pale skin and mucous membranes and general influenced state. Symptomatology started about 24 hours ago with the occurrence of the blood in stool, subsequent with progressive evolution, what led to the patient's presentation to the emergency room. At admission the general clinical examination revealed an afebrile patient, with a body mass index of 23.7 kg/m2, with pale skin and mucosa, dehydrated, hemodynamic stable with a blood pressure of 131/70mmHg and the heart rate of 88 beats per minute. Local clinical examination reveals a supple abdomen,