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Lower Gastrointestinal Hemorrhage
Davood J. Abdollahian, MD; Christos Georgiades, MD, PhD
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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)
            • 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%
            • 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%)

          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

                                  1. Feuerstein JD et al: Localizing acute lower gastrointestinal hemorrhage: CT angiography versus tagged RBC scintigraphy. AJR Am J Roentgenol. 1-7, 2016
                                  2. Zahid A et al: Making decisions using radiology in lower GI hemorrhage. Int J Surg. 31:100-3, 2016
                                  3. Chan V et al: Outcome following a negative CT angiogram for gastrointestinal hemorrhage. Cardiovasc Intervent Radiol. 38(2):329-35, 2015
                                  4. 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
                                  5. Soto JA et al: Gastrointestinal hemorrhage: evaluation with MDCT. Abdom Imaging. 40(5):993-1009, 2015
                                  6. Dariushnia SR et al: Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 25(12):1873-81, 2014
                                  7. Pillai AK et al: Segmental arterial mediolysis. Cardiovasc Intervent Radiol. 37(3):604-12, 2014
                                  8. Ali M et al: Treatment of nonvariceal gastrointestinal hemorrhage by transcatheter embolization. Radiol Res Pract. 2013:604328, 2013
                                  9. 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
                                  10. 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
                                  11. El-Tawil AM: Trends on gastrointestinal bleeding and mortality: where are we standing? World J Gastroenterol. 18(11):1154-8, 2012
                                  12. Raphaeli T et al: Current treatment of lower gastrointestinal hemorrhage. Clin Colon Rectal Surg. 25(4):219-27, 2012
                                  13. 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
                                  14. Zuccaro G: Epidemiology of lower gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 22(2):225-32, 2008
                                  Related Anatomy
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                                  Related Differential Diagnoses
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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)
                                            • 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%
                                            • 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%)

                                          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

                                                                  1. Feuerstein JD et al: Localizing acute lower gastrointestinal hemorrhage: CT angiography versus tagged RBC scintigraphy. AJR Am J Roentgenol. 1-7, 2016
                                                                  2. Zahid A et al: Making decisions using radiology in lower GI hemorrhage. Int J Surg. 31:100-3, 2016
                                                                  3. Chan V et al: Outcome following a negative CT angiogram for gastrointestinal hemorrhage. Cardiovasc Intervent Radiol. 38(2):329-35, 2015
                                                                  4. 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
                                                                  5. Soto JA et al: Gastrointestinal hemorrhage: evaluation with MDCT. Abdom Imaging. 40(5):993-1009, 2015
                                                                  6. Dariushnia SR et al: Quality improvement guidelines for diagnostic arteriography. J Vasc Interv Radiol. 25(12):1873-81, 2014
                                                                  7. Pillai AK et al: Segmental arterial mediolysis. Cardiovasc Intervent Radiol. 37(3):604-12, 2014
                                                                  8. Ali M et al: Treatment of nonvariceal gastrointestinal hemorrhage by transcatheter embolization. Radiol Res Pract. 2013:604328, 2013
                                                                  9. 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
                                                                  10. 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
                                                                  11. El-Tawil AM: Trends on gastrointestinal bleeding and mortality: where are we standing? World J Gastroenterol. 18(11):1154-8, 2012
                                                                  12. Raphaeli T et al: Current treatment of lower gastrointestinal hemorrhage. Clin Colon Rectal Surg. 25(4):219-27, 2012
                                                                  13. 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
                                                                  14. Zuccaro G: Epidemiology of lower gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 22(2):225-32, 2008