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Acute Massive Gastrointestinal Bleeding: Detection and Localization with Arterial Phase Multi–Detector Row Helical CT¹

¹ From the Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 8 Hak-dong, Dong-gu, Gwangju 501-757, Republic of Korea. Received February 3, 2005; revision requested April 4; revision received April 18; accepted June 3; final version accepted June 20. Address correspondence to W.Y. (e-mail: radyoon{at}chonnam.ac.kr).

View larger version (136K): [in a new window]   Figure 1a: Images obtained in 61-year-old man with melena for 5 days. (a) Transverse unenhanced CT image shows distended stomach filled with high-attenuating fluid with a maximum attenuation of 38 HU, indicating acute hematoma, and ascites in both perihepatic and perisplenic spaces. (b) At the same level, transverse arterial phase multi–detector row CT image depicts foci of high-attenuating extravasation of contrast material (arrows) in gastric antrum. (c) Posteroanterior celiac arteriogram and (d) right gastric arteriogram with a microcatheter reveal active bleeding (arrows) from the right gastric artery. Arrowheads on c show hemoclips used for endoscopic hemostasis.

View larger version (145K): [in a new window]   Figure 1b: Images obtained in 61-year-old man with melena for 5 days. (a) Transverse unenhanced CT image shows distended stomach filled with high-attenuating fluid with a maximum attenuation of 38 HU, indicating acute hematoma, and ascites in both perihepatic and perisplenic spaces. (b) At the same level, transverse arterial phase multi–detector row CT image depicts foci of high-attenuating extravasation of contrast material (arrows) in gastric antrum. (c) Posteroanterior celiac arteriogram and (d) right gastric arteriogram with a microcatheter reveal active bleeding (arrows) from the right gastric artery. Arrowheads on c show hemoclips used for endoscopic hemostasis.

View larger version (164K): [in a new window]   Figure 1c: Images obtained in 61-year-old man with melena for 5 days. (a) Transverse unenhanced CT image shows distended stomach filled with high-attenuating fluid with a maximum attenuation of 38 HU, indicating acute hematoma, and ascites in both perihepatic and perisplenic spaces. (b) At the same level, transverse arterial phase multi–detector row CT image depicts foci of high-attenuating extravasation of contrast material (arrows) in gastric antrum. (c) Posteroanterior celiac arteriogram and (d) right gastric arteriogram with a microcatheter reveal active bleeding (arrows) from the right gastric artery. Arrowheads on c show hemoclips used for endoscopic hemostasis.

View larger version (163K): [in a new window]   Figure 1d: Images obtained in 61-year-old man with melena for 5 days. (a) Transverse unenhanced CT image shows distended stomach filled with high-attenuating fluid with a maximum attenuation of 38 HU, indicating acute hematoma, and ascites in both perihepatic and perisplenic spaces. (b) At the same level, transverse arterial phase multi–detector row CT image depicts foci of high-attenuating extravasation of contrast material (arrows) in gastric antrum. (c) Posteroanterior celiac arteriogram and (d) right gastric arteriogram with a microcatheter reveal active bleeding (arrows) from the right gastric artery. Arrowheads on c show hemoclips used for endoscopic hemostasis.

View larger version (128K): [in a new window]   Figure 2a: Images obtained in 62-year-old woman with massive hematochezia. (a) Transverse unenhanced CT image shows fluid-filled small bowel loops without high attenuation in the right lower quadrant of the abdomen. (b) At the same level, transverse arterial phase multi–detector row CT image demonstrates a jet of extravasated contrast material (arrow) in the small-bowel lumen. (c) Corresponding posteroanterior superior mesenteric arteriogram reveals active bleeding (arrows) in the distal ileum.

View larger version (140K): [in a new window]   Figure 2b: Images obtained in 62-year-old woman with massive hematochezia. (a) Transverse unenhanced CT image shows fluid-filled small bowel loops without high attenuation in the right lower quadrant of the abdomen. (b) At the same level, transverse arterial phase multi–detector row CT image demonstrates a jet of extravasated contrast material (arrow) in the small-bowel lumen. (c) Corresponding posteroanterior superior mesenteric arteriogram reveals active bleeding (arrows) in the distal ileum.

View larger version (204K): [in a new window]   Figure 2c: Images obtained in 62-year-old woman with massive hematochezia. (a) Transverse unenhanced CT image shows fluid-filled small bowel loops without high attenuation in the right lower quadrant of the abdomen. (b) At the same level, transverse arterial phase multi–detector row CT image demonstrates a jet of extravasated contrast material (arrow) in the small-bowel lumen. (c) Corresponding posteroanterior superior mesenteric arteriogram reveals active bleeding (arrows) in the distal ileum.

View larger version (166K): [in a new window]   Figure 3a: Images obtained in 71-year-old man with massive hematochezia. (a) Transverse unenhanced CT image shows fluid-filled colonic loops without high attenuation in the right lower quadrant of the abdomen. Mild pericolic edema in the pericolic fat also is noted. (b) At the same level, transverse arterial phase multi–detector row CT image demonstrates highly attenuating extravasated contrast material (arrows) in the lumen of the ascending colon. (c) Corresponding posteroanterior superior mesenteric arteriogram reveals multiple pseudoaneurysms with active bleeding (arrows) in the cecum.

View larger version (174K): [in a new window]   Figure 3b: Images obtained in 71-year-old man with massive hematochezia. (a) Transverse unenhanced CT image shows fluid-filled colonic loops without high attenuation in the right lower quadrant of the abdomen. Mild pericolic edema in the pericolic fat also is noted. (b) At the same level, transverse arterial phase multi–detector row CT image demonstrates highly attenuating extravasated contrast material (arrows) in the lumen of the ascending colon. (c) Corresponding posteroanterior superior mesenteric arteriogram reveals multiple pseudoaneurysms with active bleeding (arrows) in the cecum.

View larger version (166K): [in a new window]   Figure 3c: Images obtained in 71-year-old man with massive hematochezia. (a) Transverse unenhanced CT image shows fluid-filled colonic loops without high attenuation in the right lower quadrant of the abdomen. Mild pericolic edema in the pericolic fat also is noted. (b) At the same level, transverse arterial phase multi–detector row CT image demonstrates highly attenuating extravasated contrast material (arrows) in the lumen of the ascending colon. (c) Corresponding posteroanterior superior mesenteric arteriogram reveals multiple pseudoaneurysms with active bleeding (arrows) in the cecum.

View larger version (128K): [in a new window]   Figure 4a: Images obtained in 70-year-old man with massive hematochezia. (a) Transverse unenhanced CT image shows distended rectal lumen filled with high-attenuating fluid, which was considered to be hemorrhagic fluid. (b) At the same level, transverse arterial phase multi–detector row CT image demonstrates extravasated contrast material (arrows) in the rectal lumen. (c) Corresponding posteroanterior inferior mesenteric arteriogram reveals foci of active bleeding (arrows) from a branch of the superior rectal artery.

View larger version (151K): [in a new window]   Figure 4b: Images obtained in 70-year-old man with massive hematochezia. (a) Transverse unenhanced CT image shows distended rectal lumen filled with high-attenuating fluid, which was considered to be hemorrhagic fluid. (b) At the same level, transverse arterial phase multi–detector row CT image demonstrates extravasated contrast material (arrows) in the rectal lumen. (c) Corresponding posteroanterior inferior mesenteric arteriogram reveals foci of active bleeding (arrows) from a branch of the superior rectal artery.

View larger version (164K): [in a new window]   Figure 4c: Images obtained in 70-year-old man with massive hematochezia. (a) Transverse unenhanced CT image shows distended rectal lumen filled with high-attenuating fluid, which was considered to be hemorrhagic fluid. (b) At the same level, transverse arterial phase multi–detector row CT image demonstrates extravasated contrast material (arrows) in the rectal lumen. (c) Corresponding posteroanterior inferior mesenteric arteriogram reveals foci of active bleeding (arrows) from a branch of the superior rectal artery.