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THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2021 | VOLUME 19 | ISSUE 2 | 23 on reliability of the index scope and available technical expertise. An endoscopic approach opens the potential for endoscopically delivered therapeutic options and negating the need for laparotomy. In the event of a lack of expertise or equipment such as a push enteroscope, a combined approach resulting in intra operative assisted endoscopy or intraoperative hand assisted push endoscopy as described above. In terms of imaging, a CT/CT Angiography would allow for detection of mass lesions. Even if not therapeutic, identification of lesions would allow for pre-operative planning and assist in intraoperative identification. Amongst these considerations, the haemodynamic status as well as availability of techniques, equipment and expertise must also be considered. In a resource limited environment with an actively exsanguinating patient, laparotomy should be considered as a high priority especially if repeat upper endoscopy was proven to be negative. With that being said, the advantages in angiography in surgically managing these patients must be noted in the form of definitive management of the bleed or in localization for laparotomy. Conclusion Effectively managing overt OGIB requires early recognition and deployment of a strategy tailored to the haemodynamic condition of the patient, the available resources and the technical expertise to use them. Patient co morbidities may lead to exploring non-surgical solutions first. With accurate localisation of the bleeding source routine surgical procedures can successfully address the pathologies responsible for the bleeding. References 1. Anand U, Thakur SK, Kumar S, Jha A, Prakash V. Idiopathic cystic artery aneurysm complicated with hemobilia. Ann Gastroenterol. 2011;24(2):134–6. 2. 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