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Repeat selective visceral angiography in patients with gastrointestinal bleeding of obscure origin
Insights
Repeat angiography is crucial for diagnosing obscure gastrointestinal bleeding. Initial negative results may be overcome by repeat imaging, especially in cases of profuse or intermittent bleeding.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
Background:
- Obscure gastrointestinal bleeding (GIB) presents a diagnostic challenge.
- Selective visceral angiography is a key investigation for identifying bleeding sources.
Purpose of the Study:
- To evaluate the diagnostic yield of selective visceral angiography in patients with obscure GIB.
- To identify reasons for initially negative angiograms and propose strategies for improved diagnosis.
Main Methods:
- Retrospective analysis of 56 patients with obscure GIB over 9 years.
- Selective visceral angiography performed in 30 patients, with repeat angiography in some cases.
Main Results:
- Angiography identified bleeding lesions in 24 of 30 patients.
- Six patients had initially negative angiograms, with lesions detected on repeat angiography.
- Reasons for negative initial angiograms included slow bleeding, intussusception, technical errors, and arterial spasm.
Conclusions:
- Repeat angiography is recommended for persistent or intermittent obscure GIB when initial studies are negative.
- Delayed repeat angiography can sometimes reveal vascular lesions missed in initial investigations.
Abstract:
In the past 9 years, we have operated on 56 patients with gastrointestinal bleeding of obscure origin. Selective visceral angiography demonstrated the bleeding lesions in 24 of the 30 patients who underwent this investigation. Six of these 24 patients, however, had a negative angiogram initially and the lesions were only demonstrated on a repeat angiogram. The negative initial angiograms were due to: (1) slow bleeding from lesions in two patients; (2) a small bleeding tumour that caused only intermittent jejunojejunal intussusception in one patient; (3) technical fault in one patient; and (4) spasm of the bleeding vascular lesions and their feeding arteries in two patients. We advocate repeat angiography the following day in all patients in whom profuse bleeding continues, and during the next intestinal bleeding in those whose bleeding stops after the initial negative angiography. In patients who have repeated episodes of massive bleeding, and in whom full investigations fail to reveal the bleeding source, repeat angiography carried out 4 weeks after the bleeding has stopped can sometimes demonstrate the vascular lesions.