Presentation
Hypotension. Decreased Hb. Known abdominal aortic aneurysm ?rupture.
Patient Data
No evidence of AAA rupture. No retroperitoneal hemorrhage or new stranding.
On portal venous phase there is accumulation of contrast pooling in the antrum of the stomach. No free gas to suggest perforation. No small bowel or colonic active bleeding. Small bowel demonstrates normal enhancement.
Red arrow indicates the site of contrast pooling in the antrum of the stomach. This on seen on this portal venous phase image.
Case Discussion
The patient proceeded to endoscopy, where a bleeding gastric ulcer was cauterised.
The sensitivity of CT angiography in detecting gastrointestinal bleeding is increased when it is active, thus when there is concern of active GI bleeding, the examination should not be unnecessarily delayed.