In order to provide appropriate and timely treatment for an acute gastrointestinal bleed, it is vital to determine the site of hemorrhage. Historical clues and exam may be insufficient to differentiate upper from lower gastrointes- tinal bleeds and clinicians may utilize nasogastric lavage for diagnostic clarity. Nasogastric tube placement is a common procedure in the Emergency Department and is often viewed as benign. We present a patient presenting with hematochezia that developed pneumoperitineum secondary to nasogastric tube perforation of the gastric wall and discuss the literature regarding gastric lavage in the setting of gastrointestinal bleed.
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