Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT

Abstract

The purpose of this study was to evaluate the accuracy of multi-detector row helical CT (MDCT) for detection and localization of acute upper and lower gastrointestinal (GI) hemorrhage or intraperitoneal bleeding. Thirty-six consecutive patients with clinical signs of acute bleeding underwent biphasic (16- or 40-channel) MDCT. MDCT findings were correlated with endoscopy, angiography or surgery. Among the 36 patients evaluated, 26 were examined for GI bleeding and 10 for intraperitoneal hemorrhage. Confirmed sites of GI bleeding were the stomach (n = 5), duodenum (n = 5), small bowel (n = 6), large bowel (n = 8) and rectum (n = 2). The correct site of bleeding was identifiable on MDCT in 24/26 patients with GI bleeding. In 20 of these 24 patients, active CM extravasation was apparent during the exam. Among the ten patients with intraperitoneal hemorrhage, MDCT correctly identified the bleeding source in nine patients. Our findings suggest that fast and accurate localization of acute gastrointestinal and intraperitoneal bleeding is achievable on MDCT.

Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital

“…Although it has been reported, in cases of major bleeding in which the source of bleeding cannot be confirmed, computed tomography (CT) angiography and/or IVR should be performed as soon as possible for the determination of the hemostasis by IVR and surgery promptly performed (17)(18)(19).…”

Quality Improvement Guidelines for Transcatheter Embolization for Acute Gastrointestinal Nonvariceal Hemorrhage

“…Angiography and embolization generally should be considered in those cases when bleeding is identified on MDCT [1,11,20,21].…”

“…In the case of a negative finding on MDCT angiography, the probability of detection of bleeding site in DSA is low [1,11,20,21]. Surgical treatment is generally considered in operable patients especially those with a bleeding gastroduodenal peptic ulcer [22] or recurrent bleeding from colonic diverticula [23] and after endoscopy and embolization therapy failure.…”

Computed tomography angiography (CTA) in the diagnosis of an infrequent cause of gastrointestinal bleeding

“…Recently, the use of CT angiography in the study of OGIB-OO has become widespread, having proved a diagnostic yield of > 80% (8). It is a procedure that requires no special preparation, offers a high degree of sensitivity in the diagnosis of active bleeding (even flowing at rates as low as 0.5 ml/min), detects vascular abnormalities, and above all, diagnoses intestinal wall tumors as small as 1-2 cm (10).…”

“…The symptomatic cases tend to be larger tumors that often manifest as episodes of acute or chronic gastrointestinal bleeding with a high degree of vascularization and predominant exophytic growth, leading to mucosal erosion (3,4). As in other cases described in the literature, the study with UGIE, colonoscopy, and endoscopic capsule did not yield a diagnosis in the case of our patient, since the tumors were growing like a large pedicle from the intestinal wall outward, which meant that they often escaped detection in the endoscopic study of OGIB-OO (2,4,(5)(6)(7)(8)(9).…”