Multidetector CT Angiogra- phy for Acute Gastrointesti- nal Bleeding: Technique and

Jose M. Artigas, MD, PhD • Milagros Marti, MD, PhD • Jorge A. Soto, MD, PhD • Helena Esteban, MD • Inmaculada Pinilla, MD • Eugenia Guillen, MDAcute gastrointestinal bleeding is a common reason for emergency de-partment admissions and an important cause of morbidity and mortality. Factors that complicate its clinical management include patient debility due to comorbidities; intermittence of hemorrhage; and multiple sites of simultaneous bleeding. Its management, therefore, must be multidisci-plinary and include emergency physicians, gastroenterologists, and sur-geons, as well as radiologists for diagnostic imaging and interventional therapy. Upper gastrointestinal tract bleeding is usually managed endo-scopically, with radiologic intervention reserved as an alternative to be used if endoscopic therapy fails. Endoscopy is often less successful in the management of acute lower gastrointestinal tract bleeding, where colo-noscopy may be more effective. The merits of performing bowel cleansing before colonoscopy in such cases might be offset by the resultant increase in response time and should be weighed carefully against the deficits in visualization and diagnostic accuracy that would result from performing colonoscopy without bowel preparation. In recent years, multidetector computed tomographic (CT) angiography has gained acceptance as a first-line option for the diagnosis and management of lower gastrointesti-nal tract bleeding. In selected cases of upper gastrointestinal tract bleed-ing, CT angiography also provides accurate information about the pres-ence or absence of active bleeding, its source, and its cause. This informa-tion helps shorten the total diagnostic time and minimizes or eliminates the need for more expensive and more invasive procedures.