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
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
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
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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