Role of Contrast CT in Acute Lower Gastrointestinal Bleeding

Abstract

Objective: To evaluate the role of CT abdomen in the localization of acute lower gastrointestinal bleeding. Summary Background Data: The source of bleed in acute lower gastrointestinal bleeding is often difficult to localize. The role of CT in the evaluation of this group of patients has not been clearly addressed. Methods: A retrospective review of all patients with acute lower gastrointestinal bleeding over a 3-year period was carried out. When endoscopy failed to localize the source and bleeding continued, angiography and/or scintigraphy were carried out. In contrast, those who had normal endoscopies and had clinically stopped bleeding, underwent CT abdomen. Results: CT done in 7 patients with no evidence of active bleed identified a lesion in 6 (86%). Conclusions: CT may be useful in acute lower gastrointestinal bleeding where endoscopy fails to localize a lesion and bleeding has stopped temporarily.

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

“…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.…”

“…In addition, CT protocols vary considerably across the different studies. Some investigators used water as oral contrast media (CM) [6] whereas other administered oral iodinated CM [7]. 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].…”

“…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.…”

Lower Gastrointestinal Vascular Malformation in Children

“…The frequency of vascular lesions affecting the colon is unknown. The colonic vascular malformations are detected only when the child presents with LGI bleed [3]. The clinical workup is followed up with angiography, blood pool scan, magnetic resonance imaging, doppler studies and endo-sonography.…”

“…The relatively low negative predictive value of the Meckel's scan suggests that exploratory laparotomy or laparoscopy may be indicated instead of scintigraphic scanning in the assessment of the anemic (hemoglobin less than 11g/dL) pediatric patient with lower GI bleeding, especially in those with a high suspicion of Meckel's diverticulum bleed [5]. Computed tomography is useful in diagnosis of acute lower gastrointestinal bleeding where endoscopy fails to localize the lesion and bleeding has stopped temporarily [3]. In obscure GI bleed where the lesion cannot be localized the capsule endoscopy has a high diagnostic yield [6].…”