Digestive Disease Interventions 2018; 02(03): 276-286
DOI: 10.1055/s-0038-1668095
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Acute Lower Gastrointestinal Hemorrhage

David S. Shin
1   Department of Radiology, University of Washington, Seattle, Washington
,
Sean D. Pietrini
1   Department of Radiology, University of Washington, Seattle, Washington
,
Zachary T. Fitzgerald
1   Department of Radiology, University of Washington, Seattle, Washington
,
Matthew J. Kogut
1   Department of Radiology, University of Washington, Seattle, Washington
› Author Affiliations
Further Information

Publication History

28 June 2018

03 July 2018

Publication Date:
10 August 2018 (online)

Abstract

Acute lower gastrointestinal (GI) hemorrhage is a potentially life-threatening event, which requires efficient work-up and effective management. Interventional radiology has an indispensable role in treatment of this serious condition. We review the major causes of acute lower GI bleeding in adults, available diagnostic modalities, and endovascular interventions.

 
  • References

  • 1 Barnert J, Messmann H. Diagnosis and management of lower gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol 2009; 6 (11) 637-646
  • 2 Navuluri R, Kang L, Patel J, Van Ha T. Acute lower gastrointestinal bleeding. Semin Intervent Radiol 2012; 29 (03) 178-186
  • 3 Moss AJ, Tuffaha H, Malik A. Lower GI bleeding: a review of current management, controversies and advances. Int J Colorectal Dis 2016; 31 (02) 175-188
  • 4 Painter NS, Burkitt DP. Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 1975; 4 (01) 3-21
  • 5 Meyers MA, Alonso DR, Gray GF, Baer JW. Pathogenesis of bleeding colonic diverticulosis. Gastroenterology 1976; 71 (04) 577-583
  • 6 Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1997; 92 (03) 419-424
  • 7 Foutch PG, Rex DK, Lieberman DA. Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. Am J Gastroenterol 1995; 90 (04) 564-567
  • 8 Diggs NG, Holub JL, Lieberman DA, Eisen GM, Strate LL. Factors that contribute to blood loss in patients with colonic angiodysplasia from a population-based study. Clin Gastroenterol Hepatol 2011; 9 (05) 415-420 , quiz e49
  • 9 Boley SJ, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S. On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology 1977; 72 (4 Pt 1): 650-660
  • 10 Strate LL. Lower GI bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am 2005; 34 (04) 643-664
  • 11 Rosen L, Bub DS, Reed III JF, Nastasee SA. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum 1993; 36 (12) 1126-1131
  • 12 Ghassemi KA, Jensen DM. Lower GI bleeding: epidemiology and management. Curr Gastroenterol Rep 2013; 15 (07) 333
  • 13 Strate LL, Naumann CR. The role of colonoscopy and radiological procedures in the management of acute lower intestinal bleeding. Clin Gastroenterol Hepatol 2010; 8 (04) 333-343 , quiz e44
  • 14 Smith R, Copely DJ, Bolen FH. 99mTc RBC scintigraphy: correlation of gastrointestinal bleeding rates with scintigraphic findings. AJR Am J Roentgenol 1987; 148 (05) 869-874
  • 15 Darcy MD, Cash BD, Feig BW. , et al. ACR Appropriateness Criteria Radiologic Management of Lower Gastrointestinal Tract Bleeding. Available at https://acsearch.acr.org/docs/69457/Narrative/ . American College of Radiology. Accessed June 1, 2018
  • 16 García-Blázquez V, Vicente-Bártulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J. ; EBM-Connect Collaboration. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol 2013; 23 (05) 1181-1190
  • 17 Kuhle WG, Sheiman RG. Detection of active colonic hemorrhage with use of helical CT: findings in a swine model. Radiology 2003; 228 (03) 743-752
  • 18 Ernst O, Bulois P, Saint-Drenant S, Leroy C, Paris JC, Sergent G. Helical CT in acute lower gastrointestinal bleeding. Eur Radiol 2003; 13 (01) 114-117
  • 19 Miller FH, Hwang CM. An initial experience: using helical CT imaging to detect obscure gastrointestinal bleeding. Clin Imaging 2004; 28 (04) 245-251
  • 20 Walker TG. Acute gastrointestinal hemorrhage. Tech Vasc Interv Radiol 2009; 12 (02) 80-91
  • 21 Abbas SM, Bissett IP, Holden A, Woodfield JC, Parry BR, Duncan D. Clinical variables associated with positive angiographic localization of lower gastrointestinal bleeding. ANZ J Surg 2005; 75 (11) 953-957
  • 22 Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg 1986; 204 (05) 530-536
  • 23 Cohn SM, Moller BA, Zieg PM, Milner KA, Angood PB. Angiography for preoperative evaluation in patients with lower gastrointestinal bleeding: are the benefits worth the risks?. Arch Surg 1998; 133 (01) 50-55
  • 24 Koh FH, Soong J, Lieske B, Cheong WK, Tan KK. Does the timing of an invasive mesenteric angiography following a positive CT mesenteric angiography make a difference?. Int J Colorectal Dis 2015; 30 (01) 57-61
  • 25 Zahid A, Young CJ. Making decisions using radiology in lower GI hemorrhage. Int J Surg 2016; 31: 100-103
  • 26 Roy-Choudhury SH, Gallacher DJ, Pilmer J. , et al. Relative threshold of detection of active arterial bleeding: in vitro comparison of MDCT and digital subtraction angiography. AJR Am J Roentgenol 2007; 189 (05) W238-46
  • 27 Baum S, Nusbaum M, Blakemore WS, Finkelstein AK. The preoperative radiographic demonstration of intra-abdominal bleeding from undetermined sites by percutaneous selective celiac and superior mesenteric arteriography. Surgery 1965; 58 (05) 797-805
  • 28 Baum S. Role of angiography in the diagnosis and treatment of gastrointestinal bleeding: historical perspective. J Vasc Interv Radiol 2018; 29 (06) 905-907
  • 29 Geronilla DR, Sampliner JE, Lerner A. Gastrointestinal bleeding: treatment with intra-arterial vasopressin. Am Surg 1975; 41 (05) 321-326
  • 30 Rabe FE, Yune HY, Klatte EC, Miller RE. Efficacy of glucagon for abdominal digital angiography. AJR Am J Roentgenol 1982; 139 (03) 618-619
  • 31 Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. Gastroenterology 1988; 95 (06) 1569-1574
  • 32 Ring EJ, Athanasoulis CA, Waltman AC, Baum S. The pseudo-vein: an angiographic appearance of arterial hemorrhage. J Can Assoc Radiol 1973; 24 (03) 242-244
  • 33 Padia SA, Geisinger MA, Newman JS, Pierce G, Obuchowski NA, Sands MJ. Effectiveness of coil embolization in angiographically detectable versus non-detectable sources of upper gastrointestinal hemorrhage. J Vasc Interv Radiol 2009; 20 (04) 461-466
  • 34 Loffroy RF, Abualsaud BA, Lin MD, Rao PP. Recent advances in endovascular techniques for management of acute nonvariceal upper gastrointestinal bleeding. World J Gastrointest Surg 2011; 3 (07) 89-100
  • 35 Dixon S, Chan V, Shrivastava V, Anthony S, Uberoi R, Bratby M. Is there a role for empiric gastroduodenal artery embolization in the management of patients with active upper GI hemorrhage?. Cardiovasc Intervent Radiol 2013; 36 (04) 970-977
  • 36 Kuo WT, Lee DE, Saad WE, Patel N, Sahler LG, Waldman DL. Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 2003; 14 (12) 1503-1509
  • 37 Darcy M. Embolization for lower GI bleeding. In: Golzarian J, Sun S, Sharafuddin M. , eds. Vascular Embolotherapy. Berlin, Heidelberg: Springer Science & Business Media; 2006: 73-85
  • 38 Ierardi AM, Urbano J, De Marchi G. , et al. New advances in lower gastrointestinal bleeding management with embolotherapy. Br J Radiol 2016; 89 (1061): 20150934
  • 39 Weldon DT, Burke SJ, Sun S, Mimura H, Golzarian J. Interventional management of lower gastrointestinal bleeding. Eur Radiol 2008; 18 (05) 857-867
  • 40 Yata S, Ihaya T, Kaminou T. , et al. Transcatheter arterial embolization of acute arterial bleeding in the upper and lower gastrointestinal tract with N-butyl-2-cyanoacrylate. J Vasc Interv Radiol 2013; 24 (03) 422-431
  • 41 Kodani M, Yata S, Ohuchi Y, Ihaya T, Kaminou T, Ogawa T. Safety and risk of superselective transcatheter arterial embolization for acute lower gastrointestinal hemorrhage with N-butyl cyanoacrylate: angiographic and colonoscopic evaluation. J Vasc Interv Radiol 2016; 27 (06) 824-830
  • 42 Zhao Y, Li G, Yu X, Xie P. Evaluation of superselective transcatheter arterial embolization with n-butyl cyanoacrylate in treating lower gastrointestinal bleeding: a retrospective study on seven cases. Gastroenterol Res Pract 2016; 2016: 8384349
  • 43 Urbano J, Manuel Cabrera J, Franco A, Alonso-Burgos A. Selective arterial embolization with ethylene-vinyl alcohol copolymer for control of massive lower gastrointestinal bleeding: feasibility and initial experience. J Vasc Interv Radiol 2014; 25 (06) 839-846
  • 44 Valji K. Cyanoacrylates for embolization in gastrointestinal bleeding: how super is glue?. J Vasc Interv Radiol 2014; 25 (01) 20-21
  • 45 Ryan JM, Key SM, Dumbleton SA, Smith TP. Nonlocalized lower gastrointestinal bleeding: provocative bleeding studies with intraarterial tPA, heparin, and tolazoline. J Vasc Interv Radiol 2001; 12 (11) 1273-1277
  • 46 Johnston C, Tuite D, Pritchard R, Reynolds J, McEniff N, Ryan JM. Use of provocative angiography to localize site in recurrent gastrointestinal bleeding. Cardiovasc Intervent Radiol 2007; 30 (05) 1042-1046
  • 47 Kim CY, Suhocki PV, Miller Jr MJ, Khan M, Janus G, Smith TP. Provocative mesenteric angiography for lower gastrointestinal hemorrhage: results from a single-institution study. J Vasc Interv Radiol 2010; 21 (04) 477-483
  • 48 Evangelista PT, Hallisey MJ. Transcatheter embolization for acute lower gastrointestinal hemorrhage. J Vasc Interv Radiol 2000; 11 (05) 601-606
  • 49 Maleux G, Roeflaer F, Heye S. , et al. Long-term outcome of transcatheter embolotherapy for acute lower gastrointestinal hemorrhage. Am J Gastroenterol 2009; 104 (08) 2042-2046
  • 50 Teng HC, Liang HL, Lin YH. , et al. The efficacy and long-term outcome of microcoil embolotherapy for acute lower gastrointestinal bleeding. Korean J Radiol 2013; 14 (02) 259-268
  • 51 Ali M, Ul Haq T, Salam B, Beg M, Sayani R, Azeemuddin M. Treatment of nonvariceal gastrointestinal hemorrhage by transcatheter embolization. Radiol Res Pract 2013; 2013: 604328
  • 52 Tan KK, Strong DH, Shore T, Ahmad MR, Waugh R, Young CJ. The safety and efficacy of mesenteric embolization in the management of acute lower gastrointestinal hemorrhage. Ann Coloproctol 2013; 29 (05) 205-208
  • 53 Hur S, Jae HJ, Lee M, Kim HC, Chung JW. Safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding: a single-center experience with 112 patients. J Vasc Interv Radiol 2014; 25 (01) 10-19
  • 54 Chan DK, Soong J, Koh F, Tan KK, Lieske B. Predictors for outcomes after super-selective mesenteric embolization for lower gastrointestinal tract bleeding. ANZ J Surg 2016; 86 (06) 459-463
  • 55 Nykänen T, Peltola E, Kylänpää L, Udd M. Transcatheter arterial embolization in lower gastrointestinal bleeding: ischemia remains a concern even with a superselective approach. J Gastrointest Surg 2018; 16: 1-10
  • 56 Bandi R, Shetty PC, Sharma RP, Burke TH, Burke MW, Kastan D. Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 2001; 12 (12) 1399-1405
  • 57 Gillespie CJ, Sutherland AD, Mossop PJ, Woods RJ, Keck JO, Heriot AG. Mesenteric embolization for lower gastrointestinal bleeding. Dis Colon Rectum 2010; 53 (09) 1258-1264