Acute Lower Intestinal Bleeding: Feasibility and Diagnostic Performance of CT Angiography

Martí, M.; Martín, J.M.; Garzón, Gonzalo; Álvarez-Sala, R.; Soto, Jorge A.

doi:10.1148/radiol.11110326

Cited by 113 publications

(78 citation statements)

References 35 publications

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“…Lower GI hemorrhage is a common presenting symptom, especially in elderly patients, due to the higher prevalence of colonic diverticulosis and vascular disease [7]. 22.6 % of patients in our study who had acute lower GI bleed with a negative CTA required further radiological or surgical intervention to stem hemorrhage.…”

Section: Discussionmentioning

confidence: 72%

Outcome Following a Negative CT Angiogram for Gastrointestinal Hemorrhage

Chan

Tse

Dixon

et al. 2014

Cardiovasc Intervent Radiol

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Objective This study was designed to evaluate the role of a negative computed tomography angiogram (CTA) in patients who present with gastrointestinal (GI) hemorrhage. Methods A review of all patients who had CTAs for GI hemorrhage over an 8-year period from January 2005 to December 2012 was performed. Data for patient demographics, location of hemorrhage, hemodynamic stability, and details of angiograms and/or the embolization procedure were obtained from the CRIS/PACS database, interventional radiology database, secure electronic medical records, and patient's clinical notes. Results A total of 180 patients had 202 CTAs during the 8-year period: 87 CTAs were performed for upper GI hemorrhage (18 positive for active bleeding, 69 negative) and 115 for lower GI hemorrhage (37 positive for active bleeding, 78 negative); 58.7 % (37/63) of patients with upper GI bleed and 77.4 % (48/62) of patients with lower GI bleed who had an initial negative CTA did not rebleed without the need for radiological or surgical intervention. This difference was statistically significant (p = 0.04). The relative risk of rebleeding, following a negative CTA, in lower GI bleeding versus upper GI bleeding patients is 0.55 (95 % confidence interval 0.32-0.95). Conclusions Patients with upper GI bleed who had negative CTAs usually require further intervention to stop the bleeding. In contrast, most patients presenting with lower GI hemorrhage who had a negative first CTA were less likely to rebleed.

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Section: Discussionmentioning

confidence: 72%

Outcome Following a Negative CT Angiogram for Gastrointestinal Hemorrhage

Chan

Tse

Dixon

et al. 2014

Cardiovasc Intervent Radiol

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“…The risk of bowel infarction after angiographic embolization appears in around 13-33 % of patients. If the source of bleeding is not identified by endoscopy we can do an angio-computed tomography, with a diagnostic accuracy of 80-85 % (16). This technique can be useful for detecting the origin of bleeding and rule out other lesions and select the patients for arteriography.…”

Section: Discussionmentioning

confidence: 99%

Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

Couto-Worner

González-Conde

Estévez-Prieto

et al. 2013

Rev. esp. enferm. dig.

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Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting, with correct visualization of the point of bleeding. Patients recovered well avoiding other aggressive procedures such as angiography or surgery.

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“…Administration of bowel preparation, not always feasible in cases of massive bleeding, can delay the procedure for several hours; the presence of clots, blood, and stool in patients without preparation may hinder the visualization of the bleeding point, increasing the rate of incomplete studies when compared with nonemergent examinations. Furthermore, in 10-12 % of cases, the source of bleeding may be extracolonic [4]. Angiography is an invasive procedure usually reserved for therapeutic purposes in patients with more severe, life-threatening bleeding.…”

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confidence: 99%

“…Angiography is an invasive procedure usually reserved for therapeutic purposes in patients with more severe, life-threatening bleeding. Technetium 99 mlabeled red blood cell scintigraphy is more sensitive than arteriography for identifying lower rate bleeding, although its emergency availability is variable, limiting its usefulness [4]. Computed tomography (CT) and, more specifically, CT enterography is commonly used as a second-line procedure in nonemergent patients with unexplained GI bleeding after negative upper and lower endoscopy examinations [5].…”

mentioning

confidence: 99%

“…The addition of imaging phases to the CT angiography study may provide more information but also increases the total radiation dose. The highest sensitivity for detecting intestinal bleeding is achieved by means of a dual-phase protocol (arterial and portal venous phases) which improves detection of extravasated contrast medium during the arterial phase and also provides information about the cause of the bleeding [4,8], a technique not used in the accompanying study.…”

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confidence: 99%

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Multidetector CT Angiography for the Detection of Colonic Diverticular Bleeding: When, How, and Why?

Loffroy

2013

Dig Dis Sci

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Acute lower GI bleeding is responsible for 1-2 % of hospital emergencies, 15 % of which manifest as massive, lifethreatening bleeding. Initial clinical management focuses on identifying the site and cause of bleeding using scintigraphy, arteriography, and colonoscopy [1][2][3]. Although optical colonoscopy is the procedure of choice, its use poses challenges in the emergency setting [1]. Administration of bowel preparation, not always feasible in cases of massive bleeding, can delay the procedure for several hours; the presence of clots, blood, and stool in patients without preparation may hinder the visualization of the bleeding point, increasing the rate of incomplete studies when compared with nonemergent examinations. Furthermore, in 10-12 % of cases, the source of bleeding may be extracolonic [4]. Angiography is an invasive procedure usually reserved for therapeutic purposes in patients with more severe, life-threatening bleeding. Technetium 99 mlabeled red blood cell scintigraphy is more sensitive than arteriography for identifying lower rate bleeding, although its emergency availability is variable, limiting its usefulness [4]. Computed tomography (CT) and, more specifically, CT enterography is commonly used as a second-line procedure in nonemergent patients with unexplained GI bleeding after negative upper and lower endoscopy examinations [5]. Since CT is rapid, noninvasive, and highly reproducible, it is commonly used in the acute setting for evaluating patients with lower GI bleeding emergencies, although optimal timing and patient characteristics for the diagnosis of colonic diverticular bleeding have not been established. In this issue, Obana et al. [6] prospectively explored the utility of contrast-enhanced CT in 52 patients with colonic diverticular bleeding testing the hypothesis that CT complements colonoscopy in this setting. Favorable patient characteristics, based on univariate analysis, included feasibility of examination within 2 h of the last hematochezia, re-bleeding in hospital, or past history of diverticular bleeding.Detection and localization of the bleeding source enable successful catheter-directed endovascular therapy. Although emergent colonoscopy remains the primary investigation in lower GI bleeding, it is often negative or impractical during the acute phase in hemodynamically unstable patients, as confirmed in the accompanying study [6]. In many centers, CT angiography is performed if endoscopy fails to identify the bleeding source with conventional mesenteric angiography reserved for patients with CT evidence of active contrast extravasatio or hemodynamic instability due to massive hemorrhage. CT may visualize acute lower GI bleeding at a bleeding rate less than the 0.5 ml/min limit cited for mesenteric angiography, perhaps as low as 0.2 ml/min [5]. The additional information provided by CT before attempted therapeutic angiographic procedures improves the preoperative localization and characterization of the bleeding source, expediting the selective catheterization of bleeding ...

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Acute Lower Intestinal Bleeding: Feasibility and Diagnostic Performance of CT Angiography

Abstract: CT angiography performed in the emergency setting in patients with acute lower intestinal bleeding is feasible and correctly depicts the presence and location of active or recent hemorrhage, as well as the potential cause, in the majority of patients.

Cited by 113 publications

References 35 publications

Outcome Following a Negative CT Angiogram for Gastrointestinal Hemorrhage

Outcome Following a Negative CT Angiogram for Gastrointestinal Hemorrhage

Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

Multidetector CT Angiography for the Detection of Colonic Diverticular Bleeding: When, How, and Why?

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