Gastrointestinal Bleeding (Acute)

Pathway

Images

Image Gallery Note: These images open in a new page
1a		Gastrointestinal Bleeding Image 1a (Computed Tomography Angiography): Extravasated contrast in the lumen of the sigmoid colon.
1b		Image 1b (Computed Tomography Angiography): Coronal views of the same patient. Extravasated contrast is seen in the lumen of the sigmoid colon.
1c		Image 1c (Mesenteric Angiogram): Selective inferior mesenteric catheterisation demonstrates a 'blush' of extravasated contrast indicating the site of bleeding.
1d		Image 1d (Mesenteric Embolisation): Bleeding has ceased with coils deployed in the bleeding artery.
2a		Gastrointestinal Bleeding Image 2a (Computed Tomography Angiography): Active extravasation of IV contrast into the lumen of the transverse colon in the region of hepatic flexure (arrow).
2b		Image 2b (Digital Subtraction Angiography): Selective superior mesenteric artery angiography of the same patient showing contrast extravasation from a right colic artery branch (arrow).
2c		Image 2c (Digital Subtraction Angiography): Super-selective angiogram of same vessel.
2d		Image 2d (Mesenteric Embolisation): Post-embolisation image demonstrates shows no further extravasation after coiling (arrow).
3a		Gastrointestinal Bleeding Image 3a (Radionuclide RBC Scan): Extravasation of tracer in ascending colon with accumulation over time in the proximal colon.
3b		Image 3b (Angiography): Angiography of same patient demonstrating extravasation of contrast medium from a branch of the superior mesenteric artery in the ascending colon.

Teaching Points

Teaching Points

• Usually, endoscopy is the first line modality to evaluate, localise and treat patients with suspected upper GI haemorrhage.
• Usually, catheter angiography is the first line modality to evaluate, localise and treat haemodynamically unstable patients with suspected lower GI haemorrhage and unprepared bowel.
• Triphasic CT Angiogram is a rapid, non-invasive investigation that can accurately localise the site and aetiology of bleeding in patients with active bleeding.
• RBC Scintigraphy is recommended for intermittent bleeding as it allows repeated imaging over a 24 hour period.

References

References

Date of literature search: May 2016

The search methodology is available on request. Email

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

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