Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes.
10.3348/kjr.2009.10.4.384
- Author:
Jin Hyoung KIM
1
;
Ji Hoon SHIN
;
Hyun Ki YOON
;
Eun Young CHAE
;
Seung Jae MYUNG
;
Gi Young KO
;
Dong Il GWON
;
Kyu Bo SUNG
Author Information
1. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea. jhshin@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Upper gastrointestinal bleeding;
Lower gastrointestinal bleeding;
Angiography
- MeSH:
Adolescent;
Adult;
Aged;
Aged, 80 and over;
*Angiography;
Arteries;
Disseminated Intravascular Coagulation/etiology;
Embolization, Therapeutic;
Female;
Gastrointestinal Hemorrhage/*radiography/surgery;
Hemodynamics;
Humans;
Male;
Middle Aged;
Recurrence
- From:Korean Journal of Radiology
2009;10(4):384-390
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding. MATERIALS AND METHODS:From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined. RESULTS: The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 +/- 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding. CONCLUSION: Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.
