Blood in the gut: jets, clots and tricks. Role of MSCT in GI bleeding

Congress:

ECR 2012

Poster Number:

C-0632

Type:

Educational Exhibit

Keywords:

Haemorrhage, Diagnostic procedure, CT-Angiography, Emergency, Abdomen

Authors:

J. M. Artigas Martin¹, M. Martí De Gracia², J. A. Soto³, H. Esteban Cuesta¹, A. Vicente Bartulos², M. E. Guillén Subirán¹, A. Díez Tascón²; ¹Zaragoza/ES, ²Madrid/ES, ³Boston, MA/US

DOI:

10.1594/ecr2012/C-0632

DOI-Link:

https://dx.doi.org/10.1594/ecr2012/C-0632

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Learning objectives

Fig. 1 Learning Objectives. Role of CT in acute GI bleeding 1. To describe our multi-detector CT angiography (CTA) examination protocol in patients with acute gastrointestinal bleeding (AGIB) 2. To describe the CTA findings of AGIB including active bleeding, indirect signs of recent bleeding and the most common causes of AGIB 3. To discuss the role of CTA in the clinical management of AGIB

Background

Introduction. Clinical notes Fig. 2 AGIB is a common medical emergency with annual incidence of: •Upper GI bleeding: 40-150 episodes/100.000 persons •Lower GI bleeding: 20-27 episodes/100.000 persons. The anatomical landmark to delimit high and low bleeding is the ligament of Treitz, but in clinical setting things are often not as clear, and rectal bleeding can be the first sign of an upper GI hemorrhage. The clinical presentation varies depending on the location of the source of bleeding and the volume of blood loss. Even without...

Imaging findings OR Procedure details

AGIB. MDCT examination protocol No oral contrast material or fluid. Triphasic CT examination protocol from the diaphragm to the inferior pubic ramus: Unenhanced scan (low radiation dose). Arterial phase: bolus triggering starting at 150 HU in proximal aorta. Portal phase: 70 sec. after beginning of CM injectionCM at 4 mL/sec, followed by 50 mL of saline chaser. 120 kVp, automatic tube current modulation in x, y, and z-axes. 64-detector CT scanner (Aquilion 64; Toshiba, Tokyo, Japan). Image analysis (WS): two and three-dimensional (multiplanar, volume rendered,...

Conclusion

Role of MDCT in the clinical management of AGIB. Both ends Upper GI bleeding: just when the light goes off. The standard clinical management of upper gastrointestinal bleeding focuses on endoscopy, which quickly and accurately identify and treat the bleeding lesion in most cases. This approach can be altered in two situations, where the CTA plays a key role: •when massive presence of blood and clots prevents adequate visualization •when the blood comes from a place not accessible to the endoscope (eg, small bowel, bile...

Personal Information

Thanks for your attention Artigas J, Martí M, Soto J.A et al [email protected]

References

Jensen DM. Management of patients with severe hematochezia. With all current evidence available. Am J Gastroenterol 2005;100:2403-6. Zink SI, Ohki SK, Stein B, Zambuto DA, Rosenberg RJ, Choi JJ et al. Non-invasive evaluation of active lower gastrointestinal bleeding: comparison between contrast-enhanced MDCT and 99mTc-labeled RBC scintigraphy. Am J Roentgenol 2008;191:1107-14. Tew K, Davies RP, Changez K. Jadun Gh K,Kew J. MDCT of Acute Lower Gastrointestinal Bleeding. Am J Roentgenol 2004;182:427-30. Scheffel H, Pfammatter T, Wildi S, Bauerfeind P, MarincekB, Alkadhi H. Acute gastrointestinal bleeding: detection...