Helical CT angiography in gastrointestinal bleeding of obscure origin

OBJECTIVE. The aim of the study was to verify the usefulness of helical CT angiography for diagnosis of gastrointestinal hemorrhage of obscure origin. SUBJECTS AND METHODS. Eighteen consecutive patients underwent catheterization of the abdomina aorta followed by helical CT angiography before and after intraarterial injections of a contrast medium. Helical CT angiography revealed the site of hemorrhage as an extravasation of contrast medium resulting in a hyperdense area in the intestinal lumen. All patients then underwent conventional angiography that was selective for the 13 patients in whom helical CT angiography was positive and standard for the remaining five patients with negative helical CT angiograms. RESULTS: Helical CT angiography revealed the site of hemorrhage in 13 (72%) of 18 patients. Diagnosis of bleeding site was confirmed, and the cause was established at surgery in 11 of these 13 patients. The site of bleeding for the remaining two patients was confirmed by angiography as angiodysplasia of the jejunum (n=1) and of the colon (n=1). Of the five patients with negative helical CT angiograms, location of bleeding was revealed by conventional angiography in two patients; one of the remaining three patients underwent exploratory laparotomy; and bleeding ceased in the remaining two patients, who were treated without surgery. Conventional angiography was negative for two of the 13 patients in whom helical CT angiography was positive. CONCLUSION. Despite our limited experience, helical CT angiography proved to be an easier and faster technique than conventional angiography for localizing gastrointestinal bleeding of obscure origin and useful as a guide for subsequent selective conventional angiography.