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KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
TERMINOLOGY
Definitions
- Lower gastrointestinal (LGI) hemorrhage
- Territory supplied by superior mesenteric artery (SMA) and inferior mesenteric artery (IMA)
- The middle and inferior rectal arteries are supplied by the internal iliac artery
- The internal iliac artery must be investigated in cases of distal rectal/anal hemorrhage
- Boundary between upper gastrointestinal (UGI) and LGI is celiac artery-SMA watershed zone
- Near ligament of Treitz
- Some hemorrhages supplied by both celiac and SMA (commonly 2nd and 3rd portion of duodenum)
- Territory supplied by superior mesenteric artery (SMA) and inferior mesenteric artery (IMA)
- Epidemiology
- ~ 375,000 patients receive treatment for arterial GI hemorrhage in USA annually
- ~ 20% have LGI source
- Prior to introduction of endoscopic/endovascular treatments, mortality was 25%
- Since introduction of endoscopic/endovascular treatments, mortality dropped to 5%
- ~ 375,000 patients receive treatment for arterial GI hemorrhage in USA annually
- Causes of LGI hemorrhage
- Most common cause of LGI arterial hemorrhage is diverticulitis (~ 28%)
- Secondary causes of LGI hemorrhage
- Erosive disease (~ 17%)
- Angiodyslasia (~ 15%)
- Infection/ischemia (~ 14%)
- Cancer (~ 13%)
- Other (~ 8%)
- Lower gastrointestinal (LGI) hemorrhage
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things To Do
Things to Avoid
OUTCOMES
Problems
Complications
Expected Outcome
Selected References
- Feuerstein JD et al: Localizing acute lower gastrointestinal hemorrhage: CT angiography versus tagged RBC scintigraphy. AJR Am J Roentgenol. 1-7, 2016
- Zahid A et al: Making decisions using radiology in lower GI hemorrhage. Int J Surg. 31:100-3, 2016
- Chan V et al: Outcome following a negative CT angiogram for gastrointestinal hemorrhage. Cardiovasc Intervent Radiol. 38(2):329-35, 2015
- Jacovides CL et al: Arteriography for lower gastrointestinal hemorrhage: role of preceding abdominal computed tomographic angiogram in diagnosis and localization. JAMA Surg. 150(7):650-6, 2015
- Soto JA et al: Gastrointestinal hemorrhage: evaluation with MDCT. Abdom Imaging. 40(5):993-1009, 2015
- Dariushnia SR et al: Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 25(12):1873-81, 2014
- Pillai AK et al: Segmental arterial mediolysis. Cardiovasc Intervent Radiol. 37(3):604-12, 2014
- Ali M et al: Treatment of nonvariceal gastrointestinal hemorrhage by transcatheter embolization. Radiol Res Pract. 2013:604328, 2013
- Mejaddam AY et al: Outcomes following "rescue" superselective angioembolization for gastrointestinal hemorrhage in hemodynamically unstable patients. J Trauma Acute Care Surg. 75(3):398-403, 2013
- Tan KK et al: The safety and efficacy of mesenteric embolization in the management of acute lower gastrointestinal hemorrhage. Ann Coloproctol. 29(5):205-8, 2013
- El-Tawil AM: Trends on gastrointestinal bleeding and mortality: where are we standing? World J Gastroenterol. 18(11):1154-8, 2012
- Raphaeli T et al: Current treatment of lower gastrointestinal hemorrhage. Clin Colon Rectal Surg. 25(4):219-27, 2012
- Angle JF et al: Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 21(10):1479-86, 2010
- Zuccaro G: Epidemiology of lower gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 22(2):225-32, 2008
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
TERMINOLOGY
Definitions
- Lower gastrointestinal (LGI) hemorrhage
- Territory supplied by superior mesenteric artery (SMA) and inferior mesenteric artery (IMA)
- The middle and inferior rectal arteries are supplied by the internal iliac artery
- The internal iliac artery must be investigated in cases of distal rectal/anal hemorrhage
- Boundary between upper gastrointestinal (UGI) and LGI is celiac artery-SMA watershed zone
- Near ligament of Treitz
- Some hemorrhages supplied by both celiac and SMA (commonly 2nd and 3rd portion of duodenum)
- Territory supplied by superior mesenteric artery (SMA) and inferior mesenteric artery (IMA)
- Epidemiology
- ~ 375,000 patients receive treatment for arterial GI hemorrhage in USA annually
- ~ 20% have LGI source
- Prior to introduction of endoscopic/endovascular treatments, mortality was 25%
- Since introduction of endoscopic/endovascular treatments, mortality dropped to 5%
- ~ 375,000 patients receive treatment for arterial GI hemorrhage in USA annually
- Causes of LGI hemorrhage
- Most common cause of LGI arterial hemorrhage is diverticulitis (~ 28%)
- Secondary causes of LGI hemorrhage
- Erosive disease (~ 17%)
- Angiodyslasia (~ 15%)
- Infection/ischemia (~ 14%)
- Cancer (~ 13%)
- Other (~ 8%)
- Lower gastrointestinal (LGI) hemorrhage
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things To Do
Things to Avoid
OUTCOMES
Problems
Complications
Expected Outcome
Selected References
- Feuerstein JD et al: Localizing acute lower gastrointestinal hemorrhage: CT angiography versus tagged RBC scintigraphy. AJR Am J Roentgenol. 1-7, 2016
- Zahid A et al: Making decisions using radiology in lower GI hemorrhage. Int J Surg. 31:100-3, 2016
- Chan V et al: Outcome following a negative CT angiogram for gastrointestinal hemorrhage. Cardiovasc Intervent Radiol. 38(2):329-35, 2015
- Jacovides CL et al: Arteriography for lower gastrointestinal hemorrhage: role of preceding abdominal computed tomographic angiogram in diagnosis and localization. JAMA Surg. 150(7):650-6, 2015
- Soto JA et al: Gastrointestinal hemorrhage: evaluation with MDCT. Abdom Imaging. 40(5):993-1009, 2015
- Dariushnia SR et al: Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 25(12):1873-81, 2014
- Pillai AK et al: Segmental arterial mediolysis. Cardiovasc Intervent Radiol. 37(3):604-12, 2014
- Ali M et al: Treatment of nonvariceal gastrointestinal hemorrhage by transcatheter embolization. Radiol Res Pract. 2013:604328, 2013
- Mejaddam AY et al: Outcomes following "rescue" superselective angioembolization for gastrointestinal hemorrhage in hemodynamically unstable patients. J Trauma Acute Care Surg. 75(3):398-403, 2013
- Tan KK et al: The safety and efficacy of mesenteric embolization in the management of acute lower gastrointestinal hemorrhage. Ann Coloproctol. 29(5):205-8, 2013
- El-Tawil AM: Trends on gastrointestinal bleeding and mortality: where are we standing? World J Gastroenterol. 18(11):1154-8, 2012
- Raphaeli T et al: Current treatment of lower gastrointestinal hemorrhage. Clin Colon Rectal Surg. 25(4):219-27, 2012
- Angle JF et al: Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 21(10):1479-86, 2010
- Zuccaro G: Epidemiology of lower gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 22(2):225-32, 2008
