eMedicine Specialties > Radiology > Vascular/Interventional
Gastrointestinal Bleeding, Upper: Multimedia
Updated: Sep 10, 2008
Multimedia
 | Media file 1: Case 1. Celiac arteriogram obtained in a patient with duodenal ulcer bleeding that was documented endoscopically reveals standard celiac anatomy. No obvious hemorrhage from the gastroduodenal artery is seen. |
 | Media file 2: Case 1. Image depicts selective catheterization of gastroduodenal artery (GDA). Attenuation of the GDA is secondary to recent hemorrhage and vasospasm. |
 | Media file 3: Case 1. Image obtained in a patient with recurrent duodenal ulcer bleeding depicts selective embolization of the gastroduodenal artery with coils. When prophylactic embolization is performed in duodenal bleeding, one may embolize the proximal gastroepiploic artery with coils to protect the stomach, and then embolize the branches of the gastroduodenal artery with either Ivalon or Gelfoam. |
 | Media file 4: Case 1. Arterial-phase image obtained with selective injection of the superior mesenteric artery shows no contribution of the inferior pancreaticoduodenal arcade to the duodenal ulcer; thus, no embolization was performed. Injecting the appropriate collaterals in upper GI bleeding is important to prevent further hemorrhage. |
 | Media file 5: Case 1. Late-arterial phase superior mesenteric angiogram shows no contribution of the superior mesenteric artery to the duodenal ulcer hemorrhage. |
 | Media file 6: Case 2. Selective left gastric arteriogram obtained in a patient with cirrhosis, recent upper GI bleeding, and esophageal ulcers, with diffuse hemorrhagic gastritis as demonstrated at recent endoscopy. |
 | Media file 7: Case 2. Because the patient was known to have diffuse hemorrhagic gastritis, as assessed with endoscopy, vasopressin infusion was begun at 0.2 U/min. Follow-up angiogram reveals a decrease in vascularity to the stomach. Vasopressin was continued overnight, with the patient in the ICU. The patient weaned from the medication over the following 24 hours without a recurrence of bleeding. |
 | Media file 8: Case 3. Selective celiac arteriogram reveals active bleeding in the stomach from a branch of the left gastric artery along the greater curvature of the stomach. |
 | Media file 9: Case 3. Image obtained with a selective injection of the feeding vessel of the left gastric artery shows extravasation of contrast material into the dependent portion of the stomach; this finding is the pseudovein sign. |
 | Media file 10: Case 3. Image depicts superselective angiography and embolization of branch vessel of the left gastric artery with a platinum coil using a 3F microcatheter. A persistent pseudovein sign is shown. |
 | Media file 11: Case 3. Image obtained with a selective gastroduodenal artery injection with filling of the right gastroepiploic artery shows that small branches fill the bleeding vessel along the greater curvature of the stomach. |
 | Media file 12: Case 3. Embolization of the right gastroepiploic artery with Gelfoam and a single embolization coil. |
 | Media file 13: Case 3. Image obtained with a final superior mesenteric arterial injection to evaluate the collateral contribution to bleeding. |
 | Media file 14: Case 4. CT scan obtained in a 45-year-old man with acute hematemesis reveals a left upper quadrant acute mesenteric and lesser sac hemorrhage. |
 | Media file 15: Case 4. CT image caudal to Image 14 reveals acute hemorrhage. |
 | Media file 16: Case 4. Image obtained with a selective common hepatic artery injection reveals a pseudoaneurysm in the right gastric artery, which arises from the proper hepatic artery. The pseudoaneurysm has the appearance of a double density that overlaps the origin of the gastroduodenal artery in this projection. |
 | Media file 17: Case 4. Image in a left anterior oblique projection compared with the orientation of the diagnostic angiogram depicts selective embolization of the pseudoaneurysm of the right gastric artery with coils. The patient had no further bleeding. |
 | Media file 18: Case 5. Portal venogram obtained in a patient with gastric variceal bleeding before the placement of a transjugular intrahepatic portosystemic shunt shows large gastric varices. |
 | Media file 19: Case 5. Venogram obtained after the placement of a 12-mm transjugular intrahepatic portosystemic shunt and selective coil embolization of gastric varices. |
 | Media file 20: Media file 20: Bleeding from duodenal leiomyoma. Gastroduodenal arteriogram showing a duodenal mass with active contrast extravasation (arrow). |
 | Media file 21: Media file 21: Duodenal resected specimen showing a submucosal mass with a central ulceration (arrow) (Same patient as Image 20). |
 | Media file 22: Media file 22: Gastroduodenal arteriogram with a pancreatic pseudoaneurysm (arrow). |
 | Media file 23: Media file 23: Control of upper GI hemorrhage by coil occlusion of the pancreatic artery pseudoaneurysm (arrow) (Same patient as Image 22). |
 | Media file 24: Media file 24: Hemosuccus pancreaticus in patient with upper GI hemorrhage. Splenic artery aneurysm with bleeding into the pancreatic duct (arrow). |
 | Media file 25: Media file 25: Variceal bleeding in a patient with hepatocellular carcinoma invading the portal vein. Threads and streaks sign (arrow) indicating portal vein invasion by hepatoma. |
 | Media file 26: Media file 26: Portal venous phase of a superior mesenteric angiogram showing portal vein occlusion and gastroesophageal varices (arrow) (Same patient as Image 25). |
More on Gastrointestinal Bleeding, Upper |
| Overview: Gastrointestinal Bleeding, Upper |
| Imaging: Gastrointestinal Bleeding, Upper |
| Follow-up: Gastrointestinal Bleeding, Upper |
 Multimedia: Gastrointestinal Bleeding, Upper |
| References |
| Further Reading |
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References
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Tammaro L, Di Paolo MC, Zullo A, Hassan C, Morini S, Caliendo S, et al. Endoscopic findings in patients with upper gastrointestinal bleeding clinically classified into three risk groups prior to endoscopy. World J Gastroenterol. Aug 28 2008;14(32):5046-50. [Medline].
Venbrux AC. Upper gastrointestinal bleeding: diagnostic evaluation and management. In: SCVIR Syllabus: Thoracic and Visceral Vascular Interventions. 1996: 235-46.
Rockall TA, Logan RF, Devlin HB. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ. Jul 22 1995;311(6999):222-6. [Medline].
Yavorski RT, Wong RK, Maydonovitch C. Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities. Am J Gastroenterol. Apr 1995;90(4):568-73. [Medline].
da Silveira EB, Lam E, Martel M, Bensoussan K, Barkun AN. The importance of process issues as predictors of time to endoscopy in patients with acute upper-GI bleeding using the RUGBE data. Gastrointest Endosc. Sep 2006;64(3):299-309. [Medline].
Spiegel BM, Vakil NB, Ofman JJ. Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Arch Intern Med. Jun 11 2001;161(11):1393-404. [Medline].
Lee JG, Turnipseed S, Romano PS, Vigil H, Azari R, Melnikoff N, et al. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc. Dec 1999;50(6):755-61. [Medline].
Axon AT, Bell GD, Jones RH, Quine MA, McCloy RF. Guidelines on appropriate indications for upper gastrointestinal endoscopy. Working Party of the Joint Committee of the Royal College of Physicians of London, Royal College of Surgeons of England, Royal College of Anaesthetists, Association of Surgeons, the British Society of Gastroenterology, and the Thoracic Society of Great Britain. BMJ. Apr 1 1995;310(6983):853-6. [Medline].
Lefkovitz Z, Cappell MS, Kaplan M. Radiology in the diagnosis and therapy of gastrointestinal bleeding. Gastroenterol Clin North Am. Jun 2000;29(2):489-512. [Medline].
Schillaci O, Spanu A, Tagliabue L, Filippi L, Danieli R, Palumbo B, et al. SPECT/CT with a hybrid imaging system in the study of lower gastrointestinal bleeding with technetium-99m red blood cells. Q J Nucl Med Mol Imaging. Jul 3 2008;[Medline].
Ettorre GC, Francioso G, Garribba AP. Helical CT angiography in gastrointestinal bleeding of obscure origin. AJR Am J Roentgenol. Mar 1997;168(3):727-31. [Medline].
Hawkins IF, Caridi JG, LeVeen RF. Use of carbon dioxide for the detection of gastrointestinal bleeding. In: Techniques in Vascular and Interventional Radiology. 2000: 130-8.
Laing CJ, Tobias T, Rosenblum DI, Banker WL, Tseng L, Tamarkin SW. Acute gastrointestinal bleeding: emerging role of multidetector CT angiography and review of current imaging techniques. Radiographics. Jul-Aug 2007;27(4):1055-70. [Medline].
Coldwell DM. Embolotherapy of miscellaneous lesions. In: Radiologic Interventions: Embolotherapy. 1997: 93-103.
Patel TH, Cordts PR, Abcarian P. Will transcatheter embolotherapy replace surgery in the treatment of gastrointestinal bleeding?. Curr Surg. May 2001;58(3):323-7. [Medline].
Weintraub JL, Haskal ZJ. Embolotherapy of upper gastrointestinal hemorrhage. In: Techniques in Vascular and Interventional Radiology. 2000: 162-70.
Gomes AS, Lois JF, McCoy RD. Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization. AJR Am J Roentgenol. May 1986;146(5):1031-7. [Medline].
Stuber T, Hoffmann MH, Stuber G, Klass O, Feuerlein S, Aschoff AJ. Pitfalls in detection of acute gastrointestinal bleeding with multi-detector row helical CT. Abdom Imaging. Jul 3 2008;[Medline].
Further Reading
Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. American Association for the Study of Liver Diseases - Private Nonprofit Research Organization
American College of Gastroenterology - Medical Specialty Society. 1997 (revised 2007 Sep). 17 pages. NGC:005907
Preparation of patients for GI endoscopy.
American Society for Gastrointestinal Endoscopy - Medical Specialty Society. 2003 Apr. 5 pages. NGC:003818
The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. American Association for the Study of Liver Diseases - Private Nonprofit Research Organization. 2005 Feb. 15 pages. NGC:004222
ASGE guideline: the role of endoscopy in the patient with lower-GI bleeding.
American Society for Gastrointestinal Endoscopy - Medical Specialty Society. 2005 Nov. 5 pages. NGC:004584
ASGE guideline: the role of endoscopy in acute non-variceal upper-GI hemorrhage.
American Society for Gastrointestinal Endoscopy - Medical Specialty Society. 2004 Oct. 8 pages. NGC:004062
Keywords
upper gastrointestinal bleeding, upper GI bleeding, UGIB, gastrointestinal bleeding, GI bleeding, hematemesis, variceal bleeding, upper GI hemorrhage, lower GI bleeding, LGIB, hemorrhage
