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Helical CT angiography in gastrointestinal bleeding of obscure origin
G C Ettorre1, G Francioso, A P Garribba
1Institute of Radiology, University of Bari, Italy.
Insights
Helical CT angiography is a useful and faster diagnostic tool for identifying obscure gastrointestinal bleeding compared to conventional angiography. This imaging technique aids in guiding subsequent selective conventional angiography for better patient outcomes.
Area of Science:
- Radiology
- Gastroenterology
- Medical Imaging
Background:
- Obscure gastrointestinal bleeding presents diagnostic challenges.
- Conventional angiography has limitations in diagnosing obscure gastrointestinal hemorrhage.
Purpose of the Study:
- To evaluate the utility of helical CT angiography in diagnosing gastrointestinal bleeding of unknown origin.
Main Methods:
- Eighteen patients with obscure gastrointestinal bleeding underwent helical CT angiography after aortic catheterization.
- Helical CT angiography identified bleeding sites by detecting contrast extravasation into the intestinal lumen.
- Patients with positive helical CT angiograms proceeded to conventional angiography.
Main Results:
- Helical CT angiography successfully localized the bleeding site in 72% (13 of 18) of patients.
- Surgical confirmation of bleeding source was achieved in 11 of these 13 patients.
- Conventional angiography identified bleeding in 2 additional patients with negative helical CT scans.
Conclusions:
- Helical CT angiography is an effective and rapid method for diagnosing obscure gastrointestinal bleeding.
- It serves as a valuable guide for subsequent selective conventional angiography.
- The technique offers advantages over conventional angiography in terms of speed and ease of use.
Objective:
The aim of the study was to verify the usefulness of helical CT angiography for diagnosis of gastrointestinal hemorrhage of obscure origin.
Subjects And Methods:
Eighteen consecutive patients underwent catheterization of the abdominal aorta followed by helical CT angiography before and after intraarterial injections of a contrast medium. Helical CT angiography revealed the site of hemorrhage as an extravasation of contrast medium resulting in a hyperdense area in the intestinal lumen. All patients then underwent conventional angiography that was selective for the 13 patients in whom helical CT angiography was positive and standard for the remaining five patients with negative helical CT angiograms.
Results:
Helical CT angiography revealed the site of hemorrhage in 13 (72%) of 18 patients. Diagnosis of bleeding site was confirmed, and the cause was established at surgery in 11 of these 13 patients. The site of bleeding for the remaining two patients was confirmed by angiography as angiodysplasia of the jejunum (n = 1) and of the colon (n = 1). Of the five patients with negative helical CT angiograms, location of bleeding was revealed by conventional angiography in two patients; one of the remaining three patients underwent exploratory laparotomy; and bleeding ceased in the remaining two patients, who were treated without surgery. Conventional angiography was negative for two of the 13 patients in whom helical CT angiography was positive.
Conclusion:
Despite our limited experience, helical CT angiography proved to be an easier and faster technique than conventional angiography for localizing gastrointestinal bleeding of obscure origin and useful as a guide for subsequent selective conventional angiography.