Blutungslokalisation mittels 4-Zeilen-Spiral-CT bei Patienten mit klinischen Zeichen einer akuten gastrointestinalen Hämorrhagie

Purpose: There is no gold-standard regarding the diagnostic work-up and therapy of an acute gastrointestinal (CI) hemorrhage. In most cases endoscopy provides the diagnosis but in a low percentage this modality is not feasible or negative. Purpose of this study was to evaluate the role of multi-phase Multi-Slice-Computertomography (MSCT) as a modality to diagnose and locate the site of acute Gl hemorrhage in case of unfeasible or technically difficult endoscopy. Materials and Methods: 58 patients, presenting with clinical signs of lower Gl hemorrhage, were examined through a 24-month period. Preliminary endoscopy was either negative or unfeasible. Images were obtained with a four-detector row CT with an arterial (4 × 1 mm collimation, 0.8 mm increment, 1.25 mm slice width, 120 kV, 165 mAs) and portal venous series (4 × 2,5 mm collimation, 2 mm increment, 3 mm slice width, 120 kV, 165 mAs). Time interval between endoscopy and CT varied between 30 minutes and 3 hours. The results of the MSCT were correlated with clinical course and surgical or endoscopical treatment. Results: 20 of the 58 patients (34%) undergoing MSCT had a bleeding site identified, thus providing decisive information for the following intervention. In case of a following therapeutic intervention there was 100% correlation regarding the bleeding site. In 38 of the 58 patients (66%), a bleeding site was not identified by MSCT. Twenty of these 38 patients (53%) were stable and required no further treatment. In 18 of these 38 patients further interventional therapy was required due to continuing hemorrhage and in all of those patients the bleeding site was detected by intervention. Conclusion: Compared to other diagnostic methods MSCT is a fast, widely-available and low-risk technique for the localization of active Gl hemorrhage. The clinical use seems to be justified since in more than one third of the patients, MSCT demonstrates the site of bleeding and provides decisive information for further interventional therapy. Concerning those patients, in whom MSCT is negative (38 out of 58 patients), only every second patient requires any additional diagnostic work-up.