Sabharwal Rohan, Vladica Philip, Chou Roger, Law W Phillip
Department of Radiology, Westmead Hospital, Sydney, NSW, Australia.
Eur J Radiol. 2006 May;58(2):273-9. doi: 10.1016/j.ejrad.2005.11.033. Epub 2006 Jan 18.
A pilot study to evaluate helical computer tomography (CT) as a diagnostic tool for acute lower gastrointestinal tract (GIT) bleeding. CT was compared to conventional angiography (CA) and colonoscopy for the diagnosis and detection of bleeding site in suspected cases of acute lower GIT bleeding.
Seven patients presenting with acute lower GIT bleeding, between June and November 2002, underwent CT examinations. All of these seven patients underwent CA following CT. Emergency colonoscopies were performed on five patients investigated with both CT and CA. Median delay from the most recent episode of hematochezia to CT was two and a half hours, to CA was 3h, and to colonoscopy was 4h. None of the patients underwent nuclear medicine (NM) bleeding studies.
Haemoglobin drop in all patients was greater than 15 g/L in the first 24h of presentation. The mean age was 68.86 years (range, 49-83 years). Comparing CT and CA, there were four concordant and three discordant results. Both modalities had concordant findings of two active bleeding sites, one non-bleeding rectal tumour, and one negative case result. In three patients, the source of bleeding was found on CT whereas CA was negative. Emergency colonoscopies performed in all of these three patients confirmed blood in the colon/ileum.
Early experience suggests that CT is a safe, convenient and accurate diagnostic tool for acute lower GIT haemorrhage. It raises questions regarding the sensitivity of CA. A new management algorithm for acute lower GIT haemorrhage using CT as the pre-CA screening tool is being proposed based on the preliminary findings. Positive CT will allow directed therapeutic angiography, while negative CT will triage patients into alternative management pathways.
一项评估螺旋计算机断层扫描（CT）作为急性下消化道（GIT）出血诊断工具的初步研究。将CT与传统血管造影（CA）和结肠镜检查进行比较，以诊断和检测疑似急性下消化道出血病例的出血部位。
2002年6月至11月期间，7例出现急性下消化道出血的患者接受了CT检查。这7例患者在CT检查后均接受了CA检查。对5例同时接受CT和CA检查的患者进行了急诊结肠镜检查。从最近一次便血发作到CT检查的中位延迟时间为2.5小时，到CA检查为3小时，到结肠镜检查为4小时。所有患者均未接受核医学（NM）出血研究。
所有患者在就诊的前24小时内血红蛋白下降均超过15g/L。平均年龄为68.86岁（范围49 - 83岁）。比较CT和CA，有4个结果一致，3个结果不一致。两种检查方法对两个活动性出血部位、一个非出血性直肠肿瘤和一个阴性病例结果的检查结果一致。在3例患者中，CT发现了出血源而CA检查为阴性。对所有这3例患者进行的急诊结肠镜检查均证实结肠/回肠内有血液。
早期经验表明，CT是一种安全、便捷且准确的急性下消化道出血诊断工具。这引发了关于CA敏感性的问题。基于初步研究结果，正在提出一种以CT作为CA前筛查工具的急性下消化道出血新管理算法。CT检查结果为阳性将允许进行针对性的治疗性血管造影，而CT检查结果为阴性将把患者分流到其他管理途径。
