The role of dual-phase enhanced helical computed tomography in difficult intestinal bleeding

We report a case of leiomyoma of the small bowel presenting with massive gastrointestinal (GI) bleeding that was diagnosed using dual-phase enhanced helical computed tomography (CT) in the preoperative period. A 68-year-old man was admitted to our hospital because of recurrent rectal bleeding. Gastroduodenoscopic and total colonoscopic examination results were negative; however, the patient continued to show bloody stool. Dual-phase enhanced helical CT was subsequently performed. CT revealed a hypervascular tumor, with evident extravasation of the contrast medium in the bowel lumen. We were successful in establishing the point of bleeding. Exploratory laparotomy was performed the same day. A solid round extraluminal mass was found at the proximal jejunum. Bleeding was observed over the serosal side of this tumor and segmental resection of the tumorous small intestine was performed. Pathologic examination revealed leiomyoma. Enhanced helical CT proved to be useful in localizing active GI bleeding.