Abstract Aim Acute severe gastrointestinal bleeding is a major cause of mortality, with fatality rates of 10% for upper GI bleeding (UGIB) and 3% for lower GI bleeding (LGIB). The Oakland score, with cutoff of ≤8, identifies low-risk patients suitable for discharge. This study aims to assess compliance with British Society of Gastroenterology (BSG) guidelines in managing ALGIB. Methods A retrospective single-centre study included 79 adult ALGIB patients managed by general surgery between September 1 and October 31, 2024. Data were retrieved from electronic records and analyzed using Excel and SPSS. Results The mean age was 65 years (range 28–97 years) with a 1:1 male-to-female ratio. Causes included haemorrhoids (21.5%), diverticular disease (17.7%), inflammatory bowel disease (13.9%), malignancy (10.1%) and others (radiation proctitis and infective colitis). Shock index and Oakland score documentation were 0% and 10%, respectively. Of seven CT angiograms, 43% were positive. The mean Oakland score was 16 (range 5–32), correlating with hospital stay and transfusion need. Four patients with an Oakland score ≤8 and 31 with scores >8 were discharged. Blood transfusion was required in 21% cases. Of six patients receiving tranexamic acid (TXA), three required transfusion, two had endoscopic intervention, one underwent embolisation, and one required surgery. Follow-up colonoscopy was performed in 43%. No 30-day mortality or readmissions reported. Conclusion Management of ALGIB showed poor adherence to BSG guidelines, including inadequate documentation, inappropriate discharges, and low follow-up colonoscopy rates. TXA use was limited, with mixed outcomes. Improvements in guideline compliance are needed to enhance care.