GS07 THE UTILITY OF CT ANGIOGRAPHY IN ACUTE LOWER GASTROINTESTINAL HAEMORRHAGE: A SINGLE INSTITUTION EXPERIENCE

Introduction:   Lower gastrointestinal haemorrhage (LGIH) is a major health burden. Although for the majority no intervention is required, where conservative management fails, radiological intervention is required to either localise or embolise the bleeding vessels. In recent years CT angiography (CTA) has increasingly been used for localisation. This study assesses the utilisation of this investigation in patients with acute LGIH. Methods:   A review of all patients admitted to the John Hunter Hospital, Newcastle with acute LGIH was performed and patients undergoing CTA selected. The utility and safety of CTA was assessed as well as a comparison made between positive and negative tests. Results:   Between January 2005 and August 2008 there were 334 emergency admissions with LGIH of which 79 patients underwent CTA. In 30 (38%) patients, CTA localised an active bleeding site. Of the remaining 49 CTA, other pathology was identified in 8 (10%). Overall mortality was 5% and intervention rate was 9% (4 segmental colectomy and 3 selective angiography). There was no difference in rate of intervention or mortality between the CTA positive and negative groups. Transfusion requirement (4.28 vs. 2.34 units, p < 0.05) and haemodynamic instability at the time of CTA were higher in the positive CTA group. Conclusion:   LGIH will resolve without intervention in the majority. CTA is safe and a positive test is not indicative of a higher intervention rate but provides a management strategy. We suggest it be performed on patients receiving more than 2 units of packed cells or those with haemodynamic instability.