Jejunal haemorrhage

Case contributed by Dr Ian Bickle

Presentation

Middle aged female. Haemoglobin 8.4 g/dl. OGD: gastritis. Colonoscopy normal.

Patient Data

Age: 54
Gender: Female
Modality: CT

DUAL PHASE CT ABDOMEN

Moderate amount of pooling of contrast commencing on the arterial phase and progressing on the PV phase in a midline jejunal loops immediately inferior to the mid transverse colon.

No small bowel mass.

No free gas or free fluid.

Solid organs unremarkable.

Modality: DSA (angiography)

Mesenteric angiogram

Focal irregularity with a small nidus in the jejunal artery at the mesenteric border with extravasation of the contrast in to bowel lumen.

This vessel was selectively embolized with surgicel and 1:100,000 adrenaline.

Post procedure angiogram showed no flow and no evidence of any leak.

Coeliac, superior mesenteric and both renal arteries are normal. Hepatic, left gastric and splenic arteries are normal (not shown).

Case Discussion

This is a decent example of both the role of multi-phase CT in the assessment of gastrointestinal bleeding as well as catheter angiography and its role in treatment through embolisation.

In this case the diagnosis and treatment has all been performed in the department of radiology.   

A wide range of percutaneous procedures are performed, but these are not entirely free of risk.

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Case Information

rID: 44763
Case created: 4th May 2016
Last edited: 26th Apr 2017
Inclusion in quiz mode: Included

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