Helical CT in the diagnosis of acute lower gastrointestinal haemorrhage

The Case for Computed Tomographic Angiography for Initial Management of Lower Gastrointestinal Hemorrhage

“…Th is rate is slower than the accepted lower limit of detection for conventional angiography (1,2), and indeed some series show improved detection over conventional angiography (2). Th ere is substantial evidence in the English literature that CTA of the abdomen and pelvis is a safe, fast, accessible, and accurate diagnostic modality for assessing patients presenting with acute lower intestinal bleeding (1,3).…”

“…Indeed, a formal bowel preparation may inappropriately delay care in the acute setting (1). Furthermore, colonoscopic intervention has a relatively high failure rate at 32% (9).…”

“…Furthermore, even though conventional angiography is often negative due to the intermittent nature of lower gastrointestinal bleeding, the anatomic information aff orded by a positive CTA allows for superselective catheterization of the target area to more precisely localize the bleeding site, and in selective cases, empirical embolization. At least two studies have proposed an algorithm that places CTA as the initial evaluation tool for management of acute lower gastrointestinal bleeding (1,6,8). Our experience is corroborative that this is perhaps the most appropriate fi rst diagnostic step in managing lower gastrointestinal hemorrhage.…”

“…Colonoscopy has been regarded by many sources as the standard for localization of lower gastrointestinal bleeding; however, it is relatively insensitive (70%) in the acute setting during active extravasation, particularly when bleeding is high volume and may be mixed with fecal material if a prep could not be obtained prior to the exam (1,5,(7)(8)(9). Indeed, a formal bowel preparation may inappropriately delay care in the acute setting (1).…”

“…In a stable patient, colonoscopy remains the diagnostic procedure of choice for lower gastrointestinal hemorrhage, but computed tomographic angiography (CTA) also may render an etiologic diagnosis (1). Th e main diagnostic advantage of CTA in the setting of acute life-threatening lower gastrointestinal hemorrhage is its speed.…”