MDCT of Acute Lower Gastrointestinal Bleeding

Abstract

MDCT is proposed as an alternative first-line investigation to locate lower gastrointestinal bleeding before placing the patient under observation or performing embolization or surgery.

Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT

“…However, CM extravasation as the only reliable sign of acute bleeding has been documented in only three patients. Tew et al [5] found lower GI bleeding sources using a 4-detector-row CT scanner in 54% of 13 patients. Miller et al [6] performed a triphasic CT imaging protocol with oral water in 19 patients and showed helical CT to identify a wide variety of causes of lower GI hemorrhage.…”

“…In fact, recent studies have suggested a good performance for the detection of sources of GI bleeding using CT. However, reports about the usefulness of CT in evaluating lower GI bleeding so far have been limited in number and scope [5][6][7][8][9], and studies on the utility of CT for the evaluation of patients with upper GI bleeding are mostly restricted to a few anecdotal reports [10,11]. In addition, CT protocols vary considerably across the different studies.…”

“…Some authors performed unenhanced and arterial phase CT imaging [4][5][6] whereas others have shown good conspicuity for bleeding source detection with CT after intra-arterial injection of CM with an angiography catheter placed in the celiac trunc [9]. Moreover, most of the above-mentioned studies [4,5,7,8] did not assess if CT is a method that can provide a comprehensive workup of the disease by detecting both the bleeding source and the underlying etiology, and did not investigate the role of CT in the diagnostic process of patients with GI bleeding.…”

Multidetector computed tomography in acute lower gastrointestinal bleeding

“…34 In our series, the bleeding site found with MDCT scan was in 100% of cases concordant with the site of bleeding identified by reference examinations, with only four patients with no extravasation identified by MDCT scan. The overall patientbased accuracy of MDCT scan in detecting acute lower GI bleeding was 88%, with use of CM extravasation as the only criterion for the presence of active bleeding and for locating the bleeding site, which is a good result compared to those from other retrospective studies (3 of 17 for Ernst et al, 33 and 7 of 13 for Tew et al 35 ) [33][34][35] and in concordance with the prospective study by Yoon et al 34 This is also higher than what was found in the recent prospective study by Zink et al 31 A note must be made that our population presented severe bleeding at the time of MDCT scan. We are in agreement with their findings of a higher accuracy of MDCT in cases of active bleeding at the time of the acquisition.…”

Endovascular Treatment of Upper Gastrointestinal Bleeding Detected with the Use of CT Angiography

“…If there are some clinical signs of GI bleeding and radiological signs of perigraft infection such as ectopic gas, periaortic fluid or soft tissue thickness > 5mm, loss of the fat pad between the intestine and the aorta, CT has an overall AEF diagnostic specificity of 100% and sensitivity of 50% (5). other hemorrhage sources that may be found using contrast enhancement CT are diverticular disease, angiodysplasia, neoplasms, pseudoaneurysms, aneurysms, colitis and arteriobiliary fistula after liver biopsy (6,7).…”