Gastrointestinal bleeding on CT imaging

Abstract

Purpose: To evaluate the most common localizations and causes of gastrointestinal bleeding (GIB) found on computed tomography (CT). Material and Methods: We performed a single-center retrospective study in the Radiology Department between December 2018 and September 2023. We included 48 adult patients (>18 years old) with clinically suspected GIB and signs of contrast media extravasation (CMEV) on CT images. Results: Patients’ mean age was 71.4 years, and their clinical presentation was various and consisted of rectal bleeding (58.3%), melena (12.5%), abdominal pain (6.3%), hemodynamic shock (4.2%), bleeding from ileostomy (2.1%), traumatic injury (2.1%), vomiting fresh (2.1%), and digested blood (6.3%). Three patients (6.3%) experienced no GIB symptoms. CT discovered the exact bleeding cause in 37 (77.1%) patients. Of them, the leading bleeding cause was tumor (27.0%). Other reasons included peptic ulcers (21.6%), diverticula (16.2%), post-operative bleeding (13.5%), and inflammatory disease (10.8%). Angiodysplasia, aorto-enteric fistula, ischemia, and trauma occurred once (2.7% each). The most common GIB sites were the colon (25.0%), duodenum (18.8%), small intestine, and rectum (16.7% each). Bleeding from the sigmoid colon and stomach occurred in 8.3%, from the caecum in 6.3% of patients. Embolization treatment was applied to 58.3% of patients. For others, it was either not indicated or unsuccessful. Sixteen patients (33.3%) died within three years post-GIB episode. Bleeding from tumors was more commonly found in older patients (p=0.008). Conclusion: The predominant location of GIB was the colon, and the leading cause was the tumorous mass.