Subscribe to RSS
DOI: 10.1055/s-2008-1080998
Radiographic Work-Up and Treatment of Lower Gastrointestinal Bleeding
Publication History
Publication Date:
24 July 2008 (online)
![](https://www.thieme-connect.de/media/ccrs/200803/lookinside/thumbnails/10.1055-s-2008-1080998-1.jpg)
ABSTRACT
Lower gastrointestinal hemorrhage is a common reason for hospital admission. Spontaneous cessation occurs in the majority of these patients; however, continued major bleeding is a difficult clinical problem. Emergency surgery, without prior knowledge of the bleeding site is associated with high morbidity and mortality rates. Accurate localization is therefore desirable. The authors present a review of current radiological imaging modalities and therapeutic options available to the clinician. They also provide a management algorithm to aid in the strategic management of this group of patients.
KEYWORDS
Scintigraphy - mesenteric angiography - embolization
REFERENCES
- 1 Boley S J, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S. On the nature and etiology of vascular ectasias of the colon: degenerative lesions of aging. Gastroenterology. 1997; 72 650-660
- 2 McGuire H H, Haynes B W. Massive hemorrhage from diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in 50 cases. Ann Surg. 1972; 175 847-855
- 3 Drapanas T, Pennington D G, Kappleman M, Lindsey E S. Emergency subtotal colectomy: preferred approach to management of massively bleeding diverticular disease. Ann Surg. 1973; 177 519-526
- 4 Thorne D A, Datz F L, Remley K, Christian P E. Bleeding rates necessary for detecting acute gastrointestinal bleeding with technetium-99m labeled red blood cells in an experimental model. J Nucl Med. 1987; 28 514-520
- 5 Nicholson M L, Neoptolemos J P, Sharp J F, Watkin E M, Fossard D P. Localization of lower gastrointestinal bleeding using in vivo technetium-99m labeled red blood scintigraphy. Br J Surg. 1989; 76 358-361
- 6 Hunter J M, Pezim M E. Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding. Am J Surg. 1990; 59 504-506
- 7 Moreno A J, Byrd B F, Berger D E et al.. Abdominal varices mimicking an acute gastrointestinal haemorrhage during technetium-99m red blood scintigraphy. Clin Nucl Med. 1985; 10 248-251
- 8 Turgeon D K, Bennet J L. Meckels diverticulum. Am J Gastroenterol. 1990; 85 777-781
- 9 Sfakianakis G N, Hasse G M. Abdominal scintigraphy for ectopic gastric mucosa: a retrospective analysis of 143 studies. AJR Am J Roentgenol. 1982; 138 7-12
- 10 Schwartz M J, Lewis J H. Meckel's diverticulum: pitfalls in scintigraphic detection in the adult. Am J Gastroenterol. 1984; 79 611-618
- 11 Nusbaum M, Baum S, Kuroda K, Blakemore W S. Control of portal hypertension by selective mesenteric arterial drug infusion. Arch Surg. 1968; 97 1005-1014
- 12 Nussbaum M, Baum S, Blakemore W S, Finkelstein A K. Demonstration of intra-abdominal bleeding by selective arteriography. JAMA. 1965; 191 117-118
- 13 Athanasoulis C A, Baum S, Rosch J. Mesenteric arterial infusions of vasopressin for haemorrhage from colonic diverticulosis. Am J Surg. 1975; 129 212-216
- 14 Lefkovitz Z, Cappell M S, Lookstein R et al.. Radiologic diagnosis and treatment of gastrointestinal haemorrhage and ischaemia. Med Clin North Am. 2002; 86 1357-1399
- 15 Bookstein J J, Chosta E M, Foley D, Walker J F. Transcatheter haemostasis of gastrointestinal bleeding using modified autogenous clot. Radiology. 1974; 113 277-285
- 16 Chuang V P, Wallace S, Zornoza J, Davis L J. Transcatheter arterial occlusion in the management of rectosigmoid bleeding. Radiology. 1979; 133 605-609
- 17 Okazaki M, Higashihara H, Koganemaru F, Ono H, Kimura T. A coaxial catheter and steerable guidewire used to embolize branches of the splanchnic arteries. AJR. Am J Roentgenol. 1990; 155 405-406
- 18 Guy G E, Shetty P C, Sharma R P. Acute lower gastrointestinal haemorrhage: treatment by superselective embolization with polyvinyl alcohol particles. AJR Am J Roentgenol. 1992; 159 521-526
- 19 Silver A, Bendick P, Wasvary H. Safety and efficacy of superselective angioembolization in control of lower gastrointestinal hemorrhage. Am J Surg. 2005; 189 361-363
- 20 Burgess A N, Evans P M. Lower gastrointestinal haemorrhage and superselective angiographic embolization. ANZ J Surg. 2004; 74 635-638
- 21 Abbas S M, Bisset I P, Holden A, Woodfield J C, Parry B R, Duncan D. Clinical variables associated with positive angiographic localization of lower gastrointestinal bleeding. ANZ J Surg. 2005; 75 953-957
- 22 Bulakbasi N, Kurtaran K, Ustunsoz B, Somuncu I. Massive lower gastrointestinal haemorrhage from surgical anastomosis in patients with multi-organ trauma: treatment with subselective embolization with polyvinyl alcohol particles. Cardiovasc Intervent Radiol. 1999; 22 461-467
- 23 DeBarros J, Rosas L, Cohen J, Vignati P, Sardella W, Hallisey M. The changing paradigm for the treatment of colonic hemorrhage. Dis Colon Rectum. 2002; 45 802-808
- 24 Nicholson A A, Ettles D F, Hartley J E et al.. Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage. Gut. 1998; 43 79-84
- 25 Gomes A S, Lois J F, McCoy R D. Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin and embolization. AJR Am J Roentgenol. 1986; 146 1031-1037
- 26 Sabharwal R, Vladica P, Chou R, Law W P. Helical CT in the diagnosis of acute lower gastrointestinal haemorrhage. Eur J Radiol. 2006; 58 273-279
John E HartleyM.D.
The University of Hull, Academic Surgical Unit, Castle Hill Hospital, Castle Road
Cottingham, East Yorkshire HU16 5JQ, UK
Email: j.e.hartley@hull.ac.uk