Computed tomography angiography in patients with active gastrointestinal bleeding

Abstract

Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding.

Improving Conspicuity of the Canine Gastrointestinal Wall Using Dual Phase Contrast‐enhanced Computed Tomography: A Retrospective Cross‐sectional Study

“…In human medicine, computed tomography is broadly utilized for diagnosis and staging of gastrointestinal neoplasia, clinical workup of acute abdominal pain, detection of gastrointestinal well as inflammatory or vascular disorders and assessment of postoperative complications of gastrointestinal surgery . The utility of computed tomography (CT) for diagnostic workup of abdominal disease is established in the veterinary literature, however a limited focus has been placed on the use of computed tomography (CT) specifically for evaluation of the gastrointestinal tract .…”

Hemorragia digestiva alta diagnóstico e tratamento

“…Os achados endoscópicos IA, IB, IIA e IIB, segundo a classificação de Forrest, englobam o grupo de alto risco de ressangramento. Enquanto que Forrest IIC e Forrest III são agrupadas como de baixo risco (Tabela 3) A abordagem diagnóstica envolve métodos como a endoscopia digestiva alta, a colonoscopia óptica, a cápsula endoscópica, a cintilografia, a angiografia digital e a tomografia computadorizada (TC) mais recentemente configurada com múltiplos detectores (TCMD) 6 .…”

“…Os pacientes de alto risco devem, obrigatoriamente, realizar endoscopia precoce (menos de 24 ou de 12 horas da admissão hospitalar) assim que atingida a estabilização hemodinâmica ou da pressão arterial. Em pacientes de baixo risco, idealmente deveria ser realizado o exame antes das 24 horas, para melhor estratificação de riscos e diminuir o tempo de permanência hospitalar, a necessidade de hemotransfusões, os custos envolvidos, os ressangramentos e as indicações cirúrgicas 3,6,7 .…”

“…A cápsula endoscópica pode ser utilizada para avaliação de sangramento obscuro, sendo diagnóstica em 50-70%, evidenciando boa aplicabilidade, entretanto, não é possível a realização de biópsia, não sendo escolha em emergências. Além do que nas hemorragias maciças pode não visualizar o local do sangramento, não permitindo seu bom uso 6 .…”

Invited Commentary on “CT for Evaluation of Acute Gastrointestinal Bleeding”

“…This problem can be minimized by administering smaller volumes of the medium. At some centers, volumes as low as 60 mL have been used with good results (12).…”