Some time ago, I performed a colonoscopy on a patient who was having serious internal bleeding. He had already received multiple transfusions since he was admitted to the hospital. After obtaining informed consent for the procedure, I performed the colon exam. I encountered blood throughout the entire colon, but saw no definite bleeding site, raising the possibility that the source of blood might be higher up than the colon, such as from the stomach.
I had not considered this possibility when I met the patient, but this was now plausible. Can I proceed with the upper scope test, to which the patient did not consent, while the patient is still sedated from the colon exam?
Seasoned gastroenterologists can usually predict the site of internal bleeding based on numerous medical facts, but there are times that we are surprised or misled. Patients don’t always behave according to the textbook presentations we