Upper gastrointestinal bleeding - gastric ulcer

Case contributed by Dr Henry Knipe

Presentation

Hypotension. Decreased Hb. Known abdominal aortic aneurysm ?rupture.

Patient Data

Age: 75 years
Gender: Male

No evidence of AAA rupture. No retroperitoneal hemorrhage or new stranding.

On portal venous phase there is accumulation of contrast pooling in the antrum of the stomach. No free gas to suggest perforation. No small bowel or colonic active bleeding. Small bowel demonstrates normal enhancement.

Annotated image

Red arrow indicates the site of contrast pooling in the antrum of the stomach. This on seen on this portal venous phase image. 

Case Discussion

The patient proceeded to endoscopy, where a bleeding gastric ulcer was cauterised. 

The sensitivity of CT angiography in detecting gastrointestinal bleeding is increased when it is active, thus when there is concern of active GI bleeding, the examination should not be unnecessarily delayed. 

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