Detection of bleeding due to small bowel cholesterol emboli using helical CT examination in gastrointestinal bleeding of obscure origin

Chronic, intermittent GI bleeding is defined as obscure when routine diagno stic examinations of the GI tract, including barium and endoscopic studies, fail to reveal the cause of bleeding. Our patient had significant bleeding and extensive evaluation including upper endoscopy, small bowel enteroscop y, enteroclysis, colonoscopy, and provocative angiography with urokinase, w ithout the source of bleeding detected. This report describes a noninvasive novel approach using helical CT scanning with water as oral contrast and r apid injection of intravenous iodinated contrast material and thin slices o btained to diagnose the site of recurrent, obscure CI bleeding related to c holesterol crystal embolization to the small intestine. (Am J Gastroenterol 1999;94:3623-3625. (C) 1999 by Am. Coll. of Gastroenterology).