Traumatic gastrointestinal hemorrhage
This young male patient presented to A & E following an RTA and was haemodynamically unstable.
Dual Phase CT
Loading Stack -
0 images remaining
Intraperitoneal blood and contrast extravastation.
Arterial Phase Study; pooling of contrast in the right lower abdomen adjacent to the ileocolic branch of the SMA.
Posterior to the pool of extravastated contrast is the source of the bleeding - the ileocolic artery.
Contrast pooling in the left paracolic gutter on delayed phase imaging.
Triple phase study (unenhanced, arterial and portal venous phases) recommended.
High flow rate (4ml/sec) with a high volume (150mls) of high density (350mg/ml) advised.
Needs to be performed when patient actively bleeding for accurate detection
Can detect active bleeding as low as 0.35ml/minute.
- Yann G, Rodallec, MH, Boulay-Coletta, I, Jullès, MC, C Ridereau-Zins, C Zins, M. Multidetector CT Angiography in Acute Gastrointestinal Bleeding: Why, When, and How. May 2011 RadioGraphics, 31, E35-E46.
- Laing CJ, Tobias T, Rosenblum DI, Banker WL, Tseng L, Tamarkin SW.Acute gastrointestinal bleeding: emerging role of multidetector CT angiography and review of current imaging techniques.Radiographics. 2007. 27(4):1055-70.
- T. Stuber, M. Hoffmann, G. Stuber, O. Klass, S. Feuerlein, A. Aschoff. Pitfalls in detection of acute gastrointestinal bleeding with multi-detector row helical CT. Abdom Imaging. 2009;34(4):476-482.