Abstract
To assess the value of recently developed aggressive pharmacologic angiographic techniques for the diagnosis of acute lower gastrointestinal hemorrhage, we reviewed our experience with 63 consecutive patients referred for angiography. Hemorrhage was severe as indicated by a mean blood transfusion requirement of 9.4 units. Extravasation of contrast (46%), or an obvious vascular abnormality suggestive of a bleeding site (32%), was identified in 78% of patients. Extravasation was seen more frequently in patients with ≥3 units of transfusion (66%) than in those with <3 units of transfusion (17%,P<0.001). After the introduction of pharmacologic techniques using heparin, tolazoline, streptokinase, and indwelling arterial catheters, the percentage of studies with extravasation of contrast increased from 32 to 65% (P<0.01). Application of aggressive angiographic techniques increases the diagnostic yield of angiography in acute severe lower gastrointestinal hemorrhage while exposing the patient to modest increased procedure-related risks which can be accepted in selected patients.
Similar content being viewed by others
References
Margulis AR, Heinbecker P, Bernard HR: Operative mesenteric arteriography in the search for the site of bleeding in unexplained gastrointestinal hemorrhage. Surgery 48:534–539, 1960
Nusbaum M, Baum S: Radiographic demonstration of unknown sites of gastrointestinal bleeding. Surg Forum 14:374–375, 1963
Alavi A, Ring EJ: Localization of gastrointestinal bleeding: Superiority of99Tc sulfur colloid compared with angiography. Am J Roentgenol 137:741–748, 1981
Caos A, Benner KG, Manier J, McCarthy DM, Blessing LD, Katon RM, Gogel HK: Colonoscopy after golytely preparation in acute rectal bleeding. Clin Gastroenterol 8:46–49, 1986
Forde KA: Colonoscopy in acute rectal bleeding. Gastrointest Endosc 17:219–220, 1981
Rösch J, Keller FS, Wawrukiewicz AS, Krippaehne WW, Dotter CT: Pharmacoangiography in the diagnosis of recurrent massive lower gastrointestinal bleeding. Radiology 145:615–619, 1982
Athanasoulis CA, Galdabini JJ, Waltman AC, Novelline AS, Greenfield AJ, Ezpeleta ML: Angiodysplasia of the colon: A cause of rectal bleeding. Cardiovasc Radiol 1:3–13, 1978
Sos TA, Lee JG, Wixson D, Sniderman KW: Intermittent bleeding from minute to minute in acute massive gastrointestinal hemorrhage: Arteriographic demonstration. Am J Roentgenol 131:1015–1017, 1978
Baum S: Angiography and the gastrointestinal bleeder. Radiology 143:569–572, 1982
Hessel SJ, Adams DF, Abrams HL: Complications of angiography. Radiology 138:278–281, 1981
Allison DJ, Hemmingway AP, Cunningham DA: Angiography in gatrointestinal bleeding. Lancet 2:30–33, 1982
Bar AH, DeLaurentis DA, Parry CE, Keohane RB: Angiography in the management of massive lower gastrointestinal tract hemorrhage. Surg Gynecol Obstet 150:226–228, 1980
Casarella WJ, Galloway SJ, Taxin RN, Follett DA, Pollock EJ, Seaman WB: “Lower” gastrointestinal tract hemorrhage: New concepts based on arteriography. Am J Roentgenol 121:357–368, 1974
Calacchio TA, Forde KA, Patsas TJ, Nuney D: Impact of modern diagnostic methods on active rectal bleeding. Am J Surg 143:607–610, 1982
Nusbaum M, Baum S, Blakemore WS: Clinical experience with the diagnosis and management of gastrointestinal hemorrhage by selective mesenteric catherization. Ann Surg 170:506–514, 1969
Rahn NH, Tishler JM, Han SY, Russinovich NA: Diagnostic and interventional angiography in acute gastrointestinal hemorrhage. Radiology 143:361–366, 1982
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Koval, G., Benner, K.G., Rösch, J. et al. Aggressive angiographic diagnosis in acute lower gastrointestinal hemorrhage. Digest Dis Sci 32, 248–253 (1987). https://doi.org/10.1007/BF01297049
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01297049