Child ; Child, Preschool ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; Gastrointestinal Tract ; diagnostic imaging ; Humans ; Infant ; Male ; Radionuclide Imaging ; Sodium Pertechnetate Tc 99m

Objective To summarize the positive signs on multi-detector CT angiography (CTA) for active severe gastrointestinal bleeding (GIB).Methods We retrospectively evaluated the clinical records and CT images of 93 patients with active severe GIB confirmed by digital subtraction angiography (DSA),endoscopy or surgery. The positive CT signs indicating the locations and causes of the bleeding were recorded. Results Intraluminal extravasation of contrast material was identified in 44 cases (47.3%),vascular malformation was found in 22 cases (23.7%),gastrointestinal tumor was detected in 18 cases (19.4%),focal or segmental abnormal bowel mucosal enhancement was present in 7 cases (7.5%),and diverticulum with abnormal enhancement was found in 2 cases (2.2%). Conclusion Positive signs for active severe GIB on CT are diverse and thus should be carefully interpreted in clinical setting.
Angiography, Digital Subtraction ; Contrast Media ; Gastrointestinal Hemorrhage ; diagnostic imaging ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed

The small intestine has always been a problematic segments for endoscopic exploration in patients with obscure gastrointestinal bleeding. Recent emergence of capsule endoscopy has entailed a relevant diagnostic imaging advance for gastrointestinal conditions. Capsule endoscope can be used to detect small bowel bleeding. Some studies report that capsule endoscopy has the high diagnostic yield and is superior to enteroscopy and other diagnostic methods. We report here the first case of small bowel bleeding detected by using capsule endoscope in Korea, in a woman with hematochezia and a history of aspirin ingestion.
Aspirin ; Capsule Endoscopes ; Capsule Endoscopy* ; Diagnostic Imaging ; Eating ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Intestine, Small ; Korea ; Ulcer*

The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.
Adolescent ; Chronic Disease ; Esophageal and Gastric Varices/complications ; Esophageal and Gastric Varices/diagnostic imaging ; Esophageal and Gastric Varices/therapy ; Female ; Gastrointestinal Hemorrhage/complications ; Gastrointestinal Hemorrhage/diagnostic imaging ; Gastrointestinal Hemorrhage/therapy ; Humans ; Jejunum/pathology ; Portacaval Shunt, Surgical ; Portal Vein/diagnostic imaging ; Portal Vein/pathology ; Portal Vein/surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Venous Thrombosis/complications ; Venous Thrombosis/diagnostic imaging ; Venous Thrombosis/therapy

A 28-year-old Chinese man presented with acute bleeding per rectum. Computed tomography showed a posterior outpouching arising from the distal ileum. The outpouching had hyperaemic walls, but no active contrast extravasation was detected. Technetium-99m pertechnetate scintigraphy showed focal areas of abnormal uptake in the right side of the pelvis, superior and posterior to the urinary bladder. These areas of uptake appeared simultaneously with the gastric uptake and demonstrated gradual increase in intensity on subsequent images. The diagnosis of Meckel's diverticulum was confirmed on surgery and the lesion was resected. The clinical and imaging features of Meckel's diverticulum are discussed.
Abdominal Pain ; Adult ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; diagnostic imaging ; Humans ; Ileum ; diagnostic imaging ; Male ; Meckel Diverticulum ; diagnosis ; diagnostic imaging ; Radionuclide Imaging ; Radiopharmaceuticals ; Sodium Pertechnetate Tc 99m ; Tomography, X-Ray Computed

Wireless capsule endoscopy is currently the outstanding technical innovation in diagnostic gastrointestinal endoscopy. Especially for small bowel diseases this new technique offers several potential advantages over traditional diagnostic tools. The Given Diagnostic Imaging System (Given Imaging Ltd, Norcross, GA) consists of 3 components : the M2A capsule, an external receiving antenna with an attached portable hard drive, and a personal computer workstation for review and interpretation of images. The M2A capsule is a single-use device measuring 11x 26 mm and weighing 3.7 g. It is made of a biocompatible plastic and contains a complimentary metal oxide silicon chip camera, lens, light source, battery, and radio telemetry transmitter. Images are transmitted at 2 per second to an antenna array worn on the abdomen and stored on a Walkman-sized data recorder. The Given system was approved by the Food and Drug Administration in August 2001. The method has chiefly been used in patients with obscure gastrointestinal bleeding, and in some cases has allowed additional diagnoses to be made in comparison with push enteroscopy, with a positive influence on patient management. Contraindications to performance of capsule endoscopy include known or suspected GI obstruction, strictures or fistula, and presence of a cardiac pacemaker, defibrillator, or other implanted electromedical device. The M2A capsule is probably just the first in a long line of wireless endoscopic devices. There are already prototypes of self-propelled devices. Soon to come will real-time imaging, devices to image the proximal GI tract and colon, and devices that can take biopsies or provide therapy.
Abdomen ; Biopsy ; Capsule Endoscopes* ; Capsule Endoscopy ; Colon ; Constriction, Pathologic ; Defibrillators ; Diagnosis ; Diagnostic Imaging ; Endoscopy, Gastrointestinal ; Fistula ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Microcomputers ; Plastics ; Telemetry ; United States Food and Drug Administration

OBJECTIVETo evaluate the efficacy of early superselective angiography and embolization in the diagnosis and treatment of massive bleeding after gastrectomy.

METHODSThe clinical data of 28 patients with massive bleeding after surgery from 1980 to 2001 were retrospectively analysed. All patients underwent emergency angiography and 27 of them were treated by transcatheter embolization.

RESULTSBleeding was controlled in 26 of the 28 patients (93%), recurrent bleeding occurred in 1, an recognized bleeding in 1, and abdominal pain in 1. There was no death.

CONCLUSIONSTransarterial embolization for massive bleeding after gastrectomy is safe and effective. It is suggested that early emergency angiography should be considered in all patients with massive gastrointestinal bleeding after gastrectomy.

Adult ; Aged ; Aged, 80 and over ; Angiography ; methods ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Gastrectomy ; adverse effects ; Gastrointestinal Hemorrhage ; diagnostic imaging ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage ; diagnostic imaging ; etiology ; therapy ; Retrospective Studies ; Treatment Outcome

Female ; Gastrointestinal Hemorrhage ; diagnosis ; Hematoma ; diagnosis ; diagnostic imaging ; Humans ; Intestine, Small ; blood supply ; Mesentery ; Middle Aged ; Retroperitoneal Space ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo investigate the clinical value of digital subtraction angiography (DSA) and interventional treatment in gastrointestinal arterial hemorrhage.

METHODSDSA data and experiences of interventional treatment of 78 cases with gastrointestinal arterial hemorrhage were retrospectively analyzed.

RESULTSThe positive rate of DSA diagnosis was 74%(58/78). Contrast media overflow direct sign was found in 33%(26/78) patients. Contrast media overflow direct sign of postoperative anastomotic stoma was found in 83%(15/18) patients. Hemorrhage causes of 15 cases were duodenal ulcer, 5 stomach ulcer, 2 gastric cancer, 1 Dieulafoy disease, 9 vascular malformation and dysplasia, 8 in anastomotic stoma bleeding after gastrointestinal operation, 10 hepatic artery blow out and bleeding after operation of liver disease, 5 Crohn disease, 6 intestinal tract diverticulum hemorrhage, 6 enteritis or ulcer and 3 polyp of small intestine, 1 midrange malignant small intestinal interstitial tumor, 2 well differentiated small intestine leiomyosarcoma, 5 colon and rectal cancer. Fifteen cases received arterial drug infusion and 36 received arterial embolization. Twenty-seven cases underwent operation after DSA and interventional treatment, whose coincidence with pathology was 78%(21/27). Technical success rate of arterial embolization was 86%(31/36) and clinical success rate was 72%(26/36). Technical success rate of arterial drug perfusion was 60%(9/15) and clinical success rate was 40%(6/15). Rebleeding rate was 16%(8/51) after intervention treatment. During follow-up for 2-36 months, 1 rebleeding patient received gastroscope treatment after embolization, but failed and died later. There were no severe complications,such as ischemic necrosis,in all the cases.

CONCLUSIONDSA is very important for the location and qualitation of gastrointestinal arterial hemorrhage. Transarterial drug infusion and embolization are safe and effective, and available to selective operation and complication handling.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Embolization, Therapeutic ; Female ; Gastrointestinal Hemorrhage ; diagnostic imaging ; surgery ; Hepatic Artery ; Humans ; Male ; Middle Aged ; Young Adult

BACKGROUND/AIMS: Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases. Dynamic contrast-enhanced multidetector-row CT (DCE-MDCT) is not generally recommended in OGIB patients due to its low sensitivity. However, it can be used to quickly and simply diagnose OGIB according to some guidelines. The aim of this study was to evaluate the clinical efficacy of DCE-MDCT in OGIB patients. METHODS: We retrospectively analyzed the medical records of 362 patients who underwent DCE-MDCT between March 2009 and January 2014. A total of 45 patients diagnosed with OGIB were included in this study. Their baseline characteristics and treatment procedure were analyzed retrospectively. The positive rates of DCE-MDCT for the detection of bleeding and associated factors were assessed. RESULTS: The mean age of the patients was 59 years, and males represented 51.1%. Melena was the most common symptom (44.4%). Positive rate of DCE-MDCT findings was 20.0% (9/45). Among these patients, intraluminal contrast extravasation was found in 5 patients (55.6%) and intraluminal hematoma or mass lesions were found in 2 patients each (22.2%). Thirty nine patients (86.7%) underwent conservative management, and 6 patients (13.3%) underwent specific treatment, such as endoscopic treatment, embolization, or surgery. Patients who showed positivity in DCE-MDCT more frequently received specific treatment compared with those who were negative (44.4% vs. 5.6%, p=0.010). CONCLUSIONS: Although DCE-MDCT showed a low positive rate (20.0%), positive findings of DCE-MDCT could lead to specific treatment. Positive DCE-MDCT findings play a useful role in the management of patients with OGIB.
Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage/*diagnostic imaging ; Humans ; Male ; Melena/etiology ; Middle Aged ; *Multidetector Computed Tomography ; Recurrence ; Retrospective Studies