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Cacioppa LM, Floridi C, Bruno A, Rossini N, Valeri T, Borgheresi A, Inchingolo R, Cortese F, Novelli G, Felicioli A, Torresi M, Boscarato P, Ottaviani L, Giovagnoni A. Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings. World J Radiol 2024; 16:115-127. [PMID: 38845606 PMCID: PMC11151896 DOI: 10.4329/wjr.v16.i5.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) is a severe and potentially life-threatening condition, especially in cases of delayed treatment. Computed tomography angiography (CTA) plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the haemorrhage. AIM To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic findings. METHODS In this retrospective single-centre study, 35 patients (22 men; median age 69 years; range 16-92 years) admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were enrolled. Twenty-three (65.7%) patients underwent endoscopy before CTA. Bleeding volumetry was evaluated in both arterial and venous phases via a semi-automated dedicated software. Bleeding rate was obtained from volume change between the two phases and standardised for unit time. Patients were divided into two groups, according to the angiographic signs and their concordance with CTA. RESULTS Upper bleeding accounted for 42.9% and lower GIB for 57.1%. Mean haemoglobin value at the admission was 7.7 g/dL. A concordance between positive CTA and direct angiographic bleeding signs was found in 19 (54.3%) cases. Despite no significant differences in terms of bleeding volume in the arterial phase (0.55 mL vs 0.33 mL, P = 0.35), a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography (2.06 mL vs 0.9 mL, P = 0.02). In the latter patient group, a significant increase in bleeding rate was also detected (2.18 mL/min vs 0.19 mL/min, P = 0.02). CONCLUSION In GIB of any origin, extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.
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Affiliation(s)
- Laura Maria Cacioppa
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Laura Maria Cacioppa and Chiara Floridi
| | - Chiara Floridi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Ancona 60126, Italy
- Laura Maria Cacioppa and Chiara Floridi
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Nicolò Rossini
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Tommaso Valeri
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F Miulli" Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | - Francesco Cortese
- Interventional Radiology Unit, "F Miulli" Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | | | - Alessandro Felicioli
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Mario Torresi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Pietro Boscarato
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Letizia Ottaviani
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Ancona 60126, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Ancona 60126, Italy
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Liu F, Li A, Li G, Liu H. Gastrointestinal bleeding due to obstruction of the superior mesenteric vein. J Cancer Res Ther 2024; 20:736-738. [PMID: 38687947 DOI: 10.4103/jcrt.jcrt_2249_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 10/31/2023] [Indexed: 05/02/2024]
Abstract
ABSTRACT Gastrointestinal bleeding is a common clinical symptom. Finding the underlying cause is the first step for treatment. In a few patients, this can be difficult. The present work reports on the unusual case of a 53-year-old man who presented gastrointestinal bleeding. No bleeding site was found by gastrocolonoscopy or interventional examination, but after multidisciplinary consultation, we discovered that the cause of gastrointestinal bleeding was the obstruction of the upper mesenteric vein.
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Affiliation(s)
- Feng Liu
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, Shandong, China
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Zhang X, Ni J, Zhang H, Diao M. A nomogram to predict in-hospital mortality of gastrointestinal bleeding patients in the intensive care unit. Front Med (Lausanne) 2023; 10:1204099. [PMID: 37731712 PMCID: PMC10507729 DOI: 10.3389/fmed.2023.1204099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Background Gastrointestinal bleeding (GIB) is a common condition in clinical practice, and predictive models for patients with GIB have been developed. However, assessments of in-hospital mortality due to GIB in the intensive care unit (ICU), especially in critically ill patients, are still lacking. This study was designed to screen out independent predictive factors affecting in-hospital mortality and thus establish a predictive model for clinical use. Methods This retrospective study included 1,442 patients with GIB who had been admitted to the ICU. They were selected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) 1.0 database and divided into a training group and a validation group in a ratio of 7:3. The main outcome measure was in-hospital mortality. Least absolute shrinkage and section operator (LASSO) regression was used to screen out independent predictors and create a nomogram. Results LASSO regression picked out nine independent predictors: heart rate (HR), activated partial thromboplastin time (aPTT), acute physiology score III (APSIII), sequential organ failure assessment (SOFA), cerebrovascular disease, acute kidney injury (AKI), norepinephrine, vasopressin, and dopamine. Our model proved to have excellent predictive value with regard to in-hospital mortality (the area under the receiver operating characteristic curve was 0.906 and 0.881 in the training and validation groups, respectively), as well as a good outcome on a decision curve analysis to assess net benefit. Conclusion Our model effectively predicts in-hospital mortality in patients with GIB, indicating that it may prove to be a valuable tool in future clinical practice.
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Affiliation(s)
- Xueyan Zhang
- Geriatric Medicine Center, Department of Geriatric Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jianfang Ni
- Geriatric Medicine Center, Department of Geriatric Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hongwei Zhang
- Department of Critical Care Medicine, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengyuan Diao
- Department of Critical Care Medicine, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Stein DJ, Said H, Feuerstein JD. Clinical Progress Note: Diagnostic approach to lower gastrointestinal bleeding. J Hosp Med 2022; 17:547-551. [PMID: 35535943 DOI: 10.1002/jhm.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Daniel J Stein
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hyder Said
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Hepatology and Nutrition, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Abstract
CASE SUMMARY A 73-year-old woman, who had received apixaban for therapeutic anticoagulation, presented with hypotension and hematochezia. After resuscitation, diagnostic colonoscopy revealed multiple polyps and old blood within the colonic lumen, but no active bleeding (Fig. 1). Nasogastric lavage and subsequent EGD were unremarkable. During her hospitalization, she was admitted to the intensive care unit with worsening anemia, hypotension, and hematochezia. CT angiogram showed extravasation at the transverse colon (Fig. 1). Formal angiogram was unable to localize the source of bleeding, despite provocation. Given the localization on CT angiography and the patient's clinical deterioration, she underwent hand-assisted segmental transverse colectomy. Surgical pathology was notable for multiple adenomas without dysplasia. The patient had no further episodes of GI bleeding after resection.
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Affiliation(s)
- Melissa K Drezdzon
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Fernandez-Suárez A, Yuguero Torres O. Survival Analysis of Geriatric Patients with Low Digestive Hemorrhage Attending an Emergency Department. Gerontology 2021; 67:314-319. [PMID: 33550287 DOI: 10.1159/000513245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The increase in life expectancy and low mortality have doubled the number of individuals older than 65 in the last 30 years. METHODS We conducted a retrospective study of 101 patients older than 80 years of age treated by low digestive hemorrhage (LDH) in an emergency department during 2018. Sociodemographic variables were evaluated, as well as comorbidity and survival at 18 months. Survival was assessed by a Kaplan-Meier test. RESULTS 52.5% of the subjects were women. The average comorbidity of the sample was 1.97. The survival rate per year was 60%. The finding on colonoscopy shows no association with mortality. However, those patients on anticoagulant/antiplatelet therapy have a higher survival rate. CONCLUSION Survival per year is high, so urgent colonoscopy for an LDH should be performed after evaluating the patient's stability and functional status in a scheduled and outpatient manner.
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