Gastroenterology Book

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CT Angiography in Gastrointestinal Bleeding

Aka: CT Angiography in Gastrointestinal Bleeding, CTA Abdomen for Lower GI Bleed
  1. See Also
    1. Gastrointestinal Bleeding
    2. Upper Gastrointestinal Bleeding
    3. Lower Gastrointestinal Bleeding
    4. Angiography in GI Bleeding
    5. Radionuclide Red Cell Scan
  2. Indications
    1. Brisk Gastrointestinal Bleeding obscures source on Colonoscopy
    2. Gastrointestinal Bleeding with a patient too unstable for endoscopy
    3. Acute, high risk Lower Gastrointestinal Bleeding while awaiting preparation for endoscopy
  3. Imaging
    1. CT Angiography WITHOUT Oral Contrast (preferred)
    2. Do not use high density oral or rectal contrast
      1. Oral Contrast obscures bleeding
      2. Oral Contrast not needed for other causes (e.g. Diverticulitis, ischemic bowel)
  4. Evaluation
    1. CTA may be test of choice in heavy Lower GI Bleeding in which endoscopy cannot be performed
    2. CTA may direct exploratory laparotomy (identifying source)
    3. PACS imaging density >90 Hounsfield Units (HU) is consistent with blood on CTA
  5. Efficacy
    1. Test Sensitivity for Gastrointestinal Bleeding: 38% (similar to RBC Scan)
    2. CTA localizes the bleeding source in 53% (contrast with 30% for RBC Scan)
    3. CTA without bleeding predicts lower recurrent bleeding rate
  6. References
    1. Broder (2022) Crit Dec Emerg Med 31(2): 14-5
    2. Feuerstein (2016) AJR Am J Roentgenol 207(3): 578-84 [PubMed]
    3. Kennedy (2010) J Vasc Interv Radiol 21(6):848-55 [PubMed]
    4. Chan (2015) Cardiovasc Intervent Radiol 28(2): 329-35 [PubMed]

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