HELICAL CT ANGIOGRAPHY IN GASTROINTESTINAL-BLEEDING OF OBSCURE ORIGIN

OBJECTIVE. The aim of the study was to verify the usefulness of helica l CT angiography for diagnosis of gastrointestinal hemorrhage of obscu re origin. SUBJECTS AND METHODS. Eighteen consecutive patients underwe nt catheterization of the abdomina aorta followed by helical CT angiog raphy before and after intraarterial injections of a contrast medium. Helical CT angiography revealed the site of hemorrhage as an extravasa tion of contrast medium resulting in a hyperdense area in the intestin al lumen. All patients then underwent conventional angiography that wa s selective for the 13 patients in whom helical CT angiography was pos itive and standard for the remaining five patients with negative helic al 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 con firmed by angiography as angiodysplasia of the jejunum (n=1) and of th e colon (n=1). Of the five patients with negative helical CT angiogram s, location of bleeding was revealed by conventional angiography in tw o patients; one of the remaining three patients underwent exploratory laparotomy; and bleeding ceased in the remaining two patients, who wer e treated without surgery. Conventional angiography was negative for t wo of the 13 patients in whom helical CT angiography was positive. CON CLUSION. Despite our limited experience, helical CT angiography proved to be an easier and faster technique than conventional angiography fo r localizing gastrointestinal bleeding of obscure origin and useful as a guide for subsequent selective conventional angiography.