Active colonic bleeding: importance of preliminary non-contrast, arterial phase and delayed phase imaging on CT mesenteric angiography

Case contributed by Chris O'Donnell


Recent surgical procedure on the lumbar spine. Now intermittent malaena.

Patient Data

Age: 65 years
Gender: Male

3 phase study ie preliminary non-contrast, arterial phase dynamic and delayed post contrast (5 minutes)


Small focus of contrast extravasation in the hepatic flexure adjacent to a radio-opaque foreign body (probably a tablet) seen on the preliminary non-contrast scan.  Contrast extravasation dissipates on the delayed imaging but the tablet persists

Small focus of contrast extravasation in the hepatic flexure arising from a right colic artery branch.  Successfully embolized using a small coil as shown on last image.

Case Discussion

Technique for 3 phase CT mesenteric angiography is very important.

1.  patient must be bleeding at the time of the examination and should be scanned immediately if they start to bleed (as it can be intermittent)

2.  no positive oral contrast as it will obscure detection of vascular extravasation

3.  initial non-contrast imaging to detect pre-existing radio-opaque luminal structures (as in this case)

4.  large volume IV contrast bolus and rapid imaging for maximal arterial opacification and detection of contrast leak (as in this case)

5.  delayed post contrast imaging (I use 5 minutes) to confirm that that the apparent contrast leak is not contained within a vascular structure and is dispersing into the bowel lumen (as in this case)

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