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Acute Lower GI Bleeding

Leyla Azmoun, MD
Piran Aliabadi, MD
B Leonard Holman, MD

December 11, 1995

Presentation

An 84-year-old man presented to the emergency room with rectal bleeding. On examination, bright red blood was found in the rectum.

Imaging Findings

Dynamic bleeding scintigraphy
Selective inferior mesenteric angiography

Supine and upright radiographs of the abdomen were normal.

Dynamic scintigraphy of the abdomen following the intravenous injection of Tc-99m labelled red blood cells (Dynamic GI Bleeding Scan) shows a collection of radioactivity in the left side of the pelvis (focal increased uptake) indicating bleeding in the sigmoid region (arrow).

Selective inferior mesenteric angiogram shows extravasation of contrast in the left side of the pelvis, in the region of sigmoid colon, demonstrating the bleeding site (arrow).

Transcatheter vasopressin infusion into the inferior mesenteric artery caused cessation of the bleeding. A repeat angiogram did not show extravasation of the contrast.

Diagnosis

Acute lower gastrointestinal bleeding

Discussion

Acute gastrointestinal bleeding is a potentially life threatening situation that needs prompt attention and treatment. The first study in the patient with acute upper GI bleeding is endoscopy. In the case of acute lower GI bleeding, because the presence of stool and blood may prevent the visualization of the bleeding site at colonoscopy, Tc-99m red blood cell scintigraphy is the diagnostic procedure of choice because it is sensitive in diagnosing the site of active GI bleeding. If scintigraphy demonstrates the bleeding site, the next procedure of choice is angiography. The most common causes of lower GI bleeding are diverticulosis and angiodysplasia. The bleeding rate must be more than 0.5 ml/minute to locate the bleeding site by angiography. Transcatheter embolization or vasopressin infusion are effective in stopping the hemorrhage.

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