不明原因消化道出血的影像学检查

消化道出血的检查方法有消化道内镜、影像学和手术探查,其中影像学检查大多无创,对进一步消化道内镜检查、介入栓塞治疗和手术治疗均有指导意义。其中显性出血的影像学检查以CT血管造影、DSA和99mTc-RBC显像为主要检查方法,隐性出血的主要成像方法有CT小肠造影、99mTcO4-显像。当胃镜和结肠镜检查未发现异常,推测出血可能源于小肠时,需进行小肠检查。目前CT小肠造影不仅有可能检测到小肠隐匿性出血,而且还可以提供肠腔内外的病变信息,达到病因诊断。     

Acute radiologic intervention in gastrointestinal bleeding

A case of embolization of the gastroduodenal artery in a 38-year old man with chronic pancreatitis and uncontrollable bleeding is presented. The advantage of this interventional radiologic procedure is discussed and in selective cases it seems to be the choice of treatment.     

Scintigraphic localization of occult gastrointestinal bleeding using a combination of 111In-labelled platelets and 99mTc sulphur colloid

Repeated scintigraphy was performed for 6 days after the injection of autologous 111In-labeled platelets in a patient showing signs of recurrent occult gastrointestinal bleeding. Colonic activity was observed 142 h post injection, at which time a superimposed study using 99mTc sulphur colloid pinpointed the source of bleeding in the transverse colon.     

Scintigraphic localization of occult gastrointestinal bleeding using a combination of 111In-labelled platelets and 99mTc sulphur colloid

Repeated scintigraphy was performed for 6 days after the injection of autologous ¹¹¹In-labelled platelets in a patient showing signs of recurrent occult gastrointestinal bleeding. Colonic activity was observed 142 h post injection, at which time a superimposed study using ^99mTc sulphur colloid pinpointed the source of bleeding in the transverse colon.     

Delayed positive gastrointestinal bleeding studies with technetium-99m-red blood cells: utility of a second injection

Two patients studied with technetium-99m-labeled red blood cells (RBCs) for gastrointestinal bleeding had positive findings only on 24-hr delayed images, at which time the site of bleeding could not be ascertained. In each instance, when additional delayed images suggested that active bleeding was occurring, a second aliquot of RBCs was labeled and injected. Sites of active hemorrhage were identified following further imaging in both patients. When delayed GI bleeding images are positive, further views should be obtained to ascertain if the pattern of intraluminal activity changes. If renewed active hemorrhage is suspected, reinjection with a second dose of labeled RBCs may identify the bleeding site.     

Urokinase in gastrointestinal tract bleeding

Selective urokinase infusion into the superior mesenteric artery allowed the accurate determination of the site of small bowel bleeding in a patient with recurrent lower gastrointestinal bleeding who bled despite resective surgery and who had negative findings on four angiograms. Fibrinolytic agents are useful in rare cases in which the need for successful and accurate diagnosis outweighs the risks of reactivating the bleeding.     

Angiography in gastrointestinal bleeding in children

Twenty-seven children aged 1 day to 16 years studied arteriographically for acute or chronic gastrointestinal bleeding were reviewed. Children with known esophageal varices and portal hypertension were excluded. Final diagnoses were made in 25 patients by means of surgery, endoscopy, biopsy, laboratory data, and clinical follow-up. Of these 25 cases, arteriography gave a correct diagnosis in 64% and was falsely negative in 36%. In acute gastrointestinal bleeding, arteriographic diagnosis was correct in 71% and falsely negative in 29%. In chronic or recurrent gastrointestinal bleeding, arteriographic diagnosis was correct in 55% and falsely negative in 45%. The common causes of bleeding in this study were gastric and duodenal ulcers, gastritis, vascular malformations, and typhlitis. Transcatheter therapy was attempted in six acute bleeders, with success in three (50%).     

Endoscopic approach to the treatment of gastrointestinal bleeding

Gastrointestinal endoscopy is the primary diagnostic and therapeutic modality in the management of gastrointestinal bleeding. Esophagogastroduodenoscopy, small bowel enteroscopy, and colonoscopy are well-established standards for initial evaluation of gastrointestinal bleeding, and have been used effectively for diagnosis, prognosis, and therapy. Although thermal, injection, and mechanical methods have been the mainstay of endoscopic therapy, promising new technologies such as endoscopic ultrasound and wireless capsule endoscopy will further advance our ability to improve morbidity and mortality from severe gastrointestinal hemorrhage. Herein we review current standards and recent advances in the endoscopic management of upper, lower, and obscure gastrointestinal bleeding.     

Intraoperative scintigraphic localization of a gastrointestinal bleeding site

We present a case report of intraoperative scintigraphic localization of an active gastrointestinal bleeding site in a 65-yr-old female who had repeatedly negative endoscopy and angiography.     

Occult gastrointestinal bleeding in rugby player

BACKGROUND: Local ischemia and mechanical trauma to hollow abdominal organs are quoted as a cause of gastrointestinal (GI) bleeding during and after long distance running. There are no data on athletes from rugby and other contact sports where mechanical trauma of the abdomen is frequent. METHODS: Occult bleeding in the stool of Croatian national rugby team players has been investigated during and after qualification match with Italy for the World Cup 1999 on June 6th 1998 in Makarska, Croatia. One player with positive test was followed and examined in detail after the game. RESULTS: Among 11 Croatian players authors discovered one with a history of GI symptoms and one with conversion of negative to positive test for occult bleeding in stool after the match. The latter player had no GI symptoms or diseases, took no medications, played only 20 minutes in the match on forward position. Conversion has been found in the second stool sample after game (24 to 48 hours after game). The athlete was followed for 18 months. Persistent low values of hemoglobin, hematocrit and serum iron were revealed, as well as expressed hemorrhoids without signs of haemorrhage or inflammation. CONCLUSIONS: Lower incidence of GI bleeding among rugby players than among long distance runners minimize the importance of mechanical abdominal trauma in the etiology of GI bleeding during sports activity. Hemorrhoids are not quoted as a cause of GI bleeding after sport activity among athletes.     

Serendipity in scintigraphic gastrointestinal bleeding studies

A retrospective review of 80 scintigraphic bleeding studies performed with Tc-99m sulfur colloid or Tc-99m labeled red blood cells showed five cases where there were abnormal findings not related to bleeding. In some cases, the abnormalities were initially confused with bleeding or could obscure an area of bleeding, while in other cases, the abnormalities represented additional clinical information. These included bone marrow replacement related to tumor and radiation therapy, hyperemia related to a uterine leiomyoma and a diverticular abscess, and a dilated abdominal aorta (aneurysm). Recognition of such abnormalities should prevent an erroneous diagnosis and the additional information may be of clinical value.     

Severe gastrointestinal tract bleeding in a two-month-old infant due to congenital intrahepatic arterioportal fistula

A 2-month-old boy was referred for assessment of severe upper gastrointestinal tract bleeding and melena. On physical examination, a continuous murmur was heard over the right upper quadrant of the abdomen. A splenomegaly and dilated veins were also noted on the abdominal wall. Liver functions were normal. There was no history of trauma or jaundice. Doppler ultrasonography, magnetic resonance arteriography and angiography suggested the presence of an intrahepatic arteriovenous fistula between the phrenic artery and the portal vein. Management consisted of successful embolization by coiling of the phrenic artery. To our knowledge this is the first documented case report of a congenital fistula between the phrenic artery and the portal vein.     

Scintigraphic demonstration of gastrointestinal bleeding due to mesenteric varices

Mesenteric varices can appear as massive, acute lower gastrointestinal bleeding. The small bowel or colon may be involved, varices usually developing at sites of previous surgery or inflammation in patients with portal hypertension. Two patients with alcoholic cirrhosis and protal hypertension presented with rectal bleeding. Tc-99m RBC studies demonstrated varices and extravasation into the adjacent bowel. The varices were documented by mesenteric angiography. Characteristic features of Tc-99m labeled RBC studies can identify mesenteric varices as the cause of intestinal bleeding and localize the abnormal vessels.