Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):160-166. 10.14701/ahbps.2021.25.1.160.

A novel concept on volumetric assessment and quantification of gastrointestinal bleed on computed tomography angiography: Observations based on a case series

• P. AP
• Gadabanahalli K
• Bhat V
• Kumar B. N. K

• KMID: 2513192
• DOI: http://doi.org/10.14701/ahbps.2021.25.1.160

Abstract

Estimation of quantity and rate of bleeding is of great value in the management of patients with acute GI bleed. Endoscopy and multiphase contrast enhanced computed tomography (MCECT) are the presently employed two important methods for this purpose. Still there is a lacuna in the methods of precise estimation of amount of bleed, which at the moment are somewhat unreliable and subjectively evaluated. We present the value of dynamic contrast-enhanced CT examination in quantitatively estimating the amount of extravasated blood with the help of three illustrative clinical examples. Technique CT examination, the methodology for assessment of quantity of bleed is presented and the discussion of existing literature regarding the estimation methods is presented.

Keyword

GI bleed; Quantitative CT; Multiphasic contrast enhanced CT; MCECT; Rate of GI bleed; Volume estimation of GI bleed

Figure

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  Fig. 1 (A) Plain CT image showing hyper-dense content in the sigmoid colon, suggestive of clots (arrow). (B) Arterial phase image shows no enlarged feeder artery. (C) Demonstrate extravasated contrast into the sigmoid lumen (open arrow). (D) Volume rendered image in the arterial phase show minimal contrast pooling in the sigmoid colon (triangle). Volume of extravasated contrast was estimated to be 0.3 cc. (E) Venous phase images of the same patient obtained 50 seconds later shows significant increase in pooled contrast within the sigmoid and rectal lumen (green, 15.5 cc).

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  Fig. 2 (A) Plain CT image shows a metallic density (surgical clip) in the region of gall bladder fossa with a heterogeneous, hypodense perihepatic collection along right lateral surface of liver. (B) Arterial phase image shows a pseudo-aneurysm. (C) Demonstrates contrast extravasation in the venous phase images. (D) Volume rendered images of arterial phase acquisition show pseudoaneurysm of cystic artery (in green). Volume 2.6 cc. (E) Venous phase images of the same patient obtained 80 seconds later shows contrast pooling around the cystic artery along with the pseudoaneurym (triangle). The combined volume of pseudoaneurysm and extravasated contrast was calculated to be 7.7 cc. Left sided pigtail catheter can also be seen in the image.

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  Fig. 3 (A) Plain CT image of upper abdomen appear normal. (B) Arterial phase image show contrast pooling within the third part of duodenum. (C) Delayed images obtained 70 seconds later showing significant pooling of contrast in the duodenum. (D) Volume rendered images of arterial phase acquisition showing mild contrast pooling in the second and third parts of duodenum (volume 4.8 cc). (E) Venous phase images obtained 70 seconds later shows significant increase in the quantity of pooled contrast (triangle). Volume 52.2 cc.

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