Departments of Radiology, Miguel Servet University Hospital, Paseo de Isabel La Católica 1-3, 50009 Zaragoza, Spain.
Radiographics. 2013 Sep-Oct;33(5):1453-70. doi: 10.1148/rg.335125072.
Acute gastrointestinal bleeding is a common reason for emergency department admissions and an important cause of morbidity and mortality. Factors that complicate its clinical management include patient debility due to comorbidities; intermittence of hemorrhage; and multiple sites of simultaneous bleeding. Its management, therefore, must be multidisciplinary and include emergency physicians, gastroenterologists, and surgeons, as well as radiologists for diagnostic imaging and interventional therapy. Upper gastrointestinal tract bleeding is usually managed endoscopically, with radiologic intervention reserved as an alternative to be used if endoscopic therapy fails. Endoscopy is often less successful in the management of acute lower gastrointestinal tract bleeding, where colonoscopy may be more effective. The merits of performing bowel cleansing before colonoscopy in such cases might be offset by the resultant increase in response time and should be weighed carefully against the deficits in visualization and diagnostic accuracy that would result from performing colonoscopy without bowel preparation. In recent years, multidetector computed tomographic (CT) angiography has gained acceptance as a first-line option for the diagnosis and management of lower gastrointestinal tract bleeding. In selected cases of upper gastrointestinal tract bleeding, CT angiography also provides accurate information about the presence or absence of active bleeding, its source, and its cause. This information helps shorten the total diagnostic time and minimizes or eliminates the need for more expensive and more invasive procedures.
急性胃肠道出血是急诊科就诊的常见原因，也是发病率和死亡率的重要原因。使其临床管理变得复杂的因素包括合并症导致的患者虚弱；出血间歇性；以及同时存在多个出血部位。因此，其管理必须是多学科的，包括急诊医师、胃肠病学家和外科医生，以及放射科医生进行诊断成像和介入治疗。上胃肠道出血通常通过内镜进行治疗，如果内镜治疗失败，则保留放射介入作为替代方法。内镜在急性下胃肠道出血的治疗中通常不太成功，在这种情况下结肠镜检查可能更有效。在这种情况下，在进行结肠镜检查前进行肠道清洁可能会增加反应时间，并且应该仔细权衡其对可视化和诊断准确性的影响，因为如果不进行肠道准备进行结肠镜检查，可能会导致这些方面的不足。近年来，多排 CT 血管造影术已被接受为下胃肠道出血诊断和治疗的一线选择。在某些上胃肠道出血的情况下，CT 血管造影术还可以提供有关是否存在活动性出血、其来源和原因的准确信息。这些信息有助于缩短总诊断时间，并最大限度地减少或消除对更昂贵和更具侵入性的程序的需求。
