title: Computed tomography angiography in patients with active gastrointestinal bleeding.
abstract: Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding.
authors.affiliation: Master, Professional Mastership Program in association with Medical Residency (Meparem), MD, Radiologist, Department of Imaging Diagnosis, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.
authors.forename: Fatima Regina Silva
authors.initials: FR
authors.lastname: Reis
authors.affiliation: PhD, MD, Radiologist, Centro Radiológico Campinas, Hospital Vera Cruz, Campinas, SP, Brazil.
authors.forename: Patricia Prando
authors.initials: PP
authors.lastname: Cardia
authors.affiliation: Private Docent, Associate Professor, Department of Imaging Diagnosis, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Ippolito
keywords: Angiography; Computed tomography; Gastrointestinal hemorrhage; Multidetector computed tomography
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