Active colonic bleed on CT

Case contributed by Dr Andrew Dixon

Presentation

Painless PR bleeding.

Patient Data

Age: 55 years
Gender: Male
CT

Active extravasation of contrast into the large bowel lumen at the junction of the descending colon and sigmoid colon is seen on the arterial phase study with further pooling of contrast on the delayed phase. There is no mass lesion at this site to suggest bleeding from a colonic malignancy, nor is there any surrounding inflammatory change to suggest diverticulitis as a cause. 

DSA (angiography)

The inferior mesenteric artery was catheterised using a 5-French VS2 catheter. Angiography demonstrates active bleeding arising from the proximal sigmoid branch, corresponding to the CT scan findings. This branch was super selectively catheterised using a microcatheter and embolisation performed with micro coils. Good technical result was obtained. 

Annotated image

Yellow arrow indicates the intravenous contrast which has extravasated into the colonic lumen during the arterial phase. 

Case Discussion

An example of how multiphase CT of the abdomen can be used to detect and localise gastrointestinal bleeding, and how catheter angiography with embolisation can be used to stop the bleeding. Angiodysplasia was most likely the cause of bleeding in this case. 

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Case information

rID: 49765
Case created: 3rd Dec 2016
Last edited: 14th Sep 2017
Inclusion in quiz mode: Included

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