CT - CT abdomen and pelvis (GI bleeding protocol)
Axial non-contrast
Axial C+ arterial phase
Coronal C+ arterial phase
Coronal MIP Arterial
Axial C+ portal venous phase
Coronal C+ portal venous phase
Coronal MIP portal venous
What are common causes of lower gastrointestinal bleeding in elderly patients?
colonic diverticula (~40%), angiodysplasia (~25%), colorectal carcinoma (~12.5%), polyps (~7.5%), and rectal trauma/fissure/haemorrhoids (~7.5%).
What is the sensitivity of CTA in detecting those bleedings?
Studies have looked at the use of CTA in the localisation of GI haemorrhage report sensitivity of ~90% when there is active bleeding but are considerably lower when the bleeding is intermittent in nature with rates reported at ~45%.
There is an active arterial contrast blush within the caecum and proximal ascending colon, just above the ileocecal valve. Scattered sigmoid colonic diverticula with no evidence of acute inflammation. Bowel is otherwise unremarkable, no evidence of obstruction. There is no free fluid or free gas. The liver, spleen, pancreas, and adrenal glands are unremarkable. Common biliary duct dilation (1.4 cm), no obstructive cause seen. Minor intrahepatic biliary dilatation. Gallbladder is unremarkable. Small cortical and para-pelvic renal cysts on the left; kidneys show normal enhancement and appearances, no hydronephrosis. No lymph node enlargement. No suspicious bone lesions are seen. Mild dependent atelectasis in both lungs bases.