CT Abdomen Pelvis (GIT bleed protocol)
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Intraluminal contrast extravasation within the first part of the duodenum. This is confirmed on PV phase study with contrast extending through the duodenum into the jejunum. The bleeding vessel arises from the celiac trunk (likely gastroduodenal artery).
The stomach and small bowel is distended, the density of the intraluminal contents consistent with blood. The wall of the proximal duodenum is markedly thickened.
The liver, gallbladder, spleen, pancreas, kidneys and adrenals are unremarkable.
Colonic diverticular disease.
There is a small volume of intraperitoneal free fluid (HU 10). No evidence of intraperitoneal haemorrhage. No free gas to suggest perforation.
Dependant atelectasis in the lungs bilaterally. Small/moderate sized right pleural effusion. Cardiomegaly and reflux of contrast into the hepatic veins suggesting a degree of right heart failure. Fluid within the subcutaneous tissues noted.
No destructive osseous lesion. Heavily calcified vasculature.Conclusion
Large volume of contrast extravasation consistent with active bleeding within the first part of the duodenum. The bleeding vessel arises from the celiac trunk, likely gastroduodenal artery.
No free gas to suggest perforation.
Findings have been discussed with the treating team and the patient will undergo embolisation.