Lower gastro-intestinal haemorrhage

Case contributed by RMH Core Conditions

Presentation

ICU patient. Post left lower lobectomy for lung cancer. ARDS. PR bleeding, anaemia and hypotension. Increasing noradrenaline requirements.

Patient Data

Age: 67
Gender: Male

Non-contrast images demonstrate dependent pooling of hyperdense material, probably blood, within the stomach, third part of the duodenum extensively within the ascending colon and also within the descending colon and rectum. On arterial phase imaging demonstrates an irregular, linear focus of dynamic contrast extravasation within the ascending colon near the hepatic flexure, that becomes larger with further intra-luminal contrast extravasation on delayed imaging.

There is a second tiny focus of probable dynamic haemorrhage within the distal sigmoid colon, with minor pooling in the delayed phase.

Further extensive dense material within the colon and small bowel also likely represents blood from previous bleeding episodes.

There is an 11mm false aneurysm arising from the anterior aspect of the right common femoral artery.

The patient is hypovolaemic as demonstrated by a flattened IVC. 

Conclusions:

Contrast extravasation near the hepatic flexure of the colon with pooling on delayed imaging in keeping with dynamic haemorrhage.

Case Discussion

The patient subsequently went to angiography, which was unremarkable with no bleeding point identified. 

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Case information

rID: 30236
Case created: 27th Jul 2014
Last edited: 10th Sep 2015
Inclusion in quiz mode: Included

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