Journal List > Korean J Gastroenterol > v.67(4) > 1007496

Jo, Song, Boo, Na, Kim, and Kim: Clinical Efficacy of Dynamic Contrastenhanced Multidetector-row Computed Tomography in Patients with Obscure Gastrointestinal Bleeding



Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases. Dynamic contrast-enhanced multidetector-row CT (DCE-MDCT) is not generally recommended in OGIB patients due to its low sensitivity. However, it can be used to quickly and simply diagnose OGIB according to some guidelines. The aim of this study was to evaluate the clinical efficacy of DCE-MDCT in OGIB patients.


We retrospectively analyzed the medical records of 362 patients who underwent DCE-MDCT between March 2009 and January 2014. A total of 45 patients diagnosed with OGIB were included in this study. Their baseline characteristics and treatment procedure were analyzed retrospectively. The positive rates of DCE-MDCT for the detection of bleeding and associated factors were assessed.


The mean age of the patients was 59 years, and males represented 51.1%. Melena was the most common symptom (44.4%). Positive rate of DCE-MDCT findings was 20.0% (9/45). Among these patients, intraluminal contrast extravasation was found in 5 patients (55.6%) and intraluminal hematoma or mass lesions were found in 2 patients each (22.2%). Thirty nine patients (86.7%) underwent conservative management, and 6 patients (13.3%) underwent specific treatment, such as endoscopic treatment, embolization, or surgery. Patients who showed positivity in DCE-MDCT more frequently received specific treatment compared with those who were negative (44.4% vs. 5.6%, p=0.010).


Although DCE-MDCT showed a low positive rate (20.0%), positive findings of DCE-MDCT could lead to specific treatment. Positive DCE-MDCT findings play a useful role in the management of patients with OGIB.


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Fig. 1.
Patient enrollment. Data on a total of 45 patients were collected retrospectively. DCE-MDCT, dynamic contrast-enhanced multidetector-row CT; GI, gastrointestinal; EGD, esophagogastroduodenoscopy; CFS, colonoscopy.
Fig. 2.
Dynamic contrast-enhanced multidetector-row CT image of a 61-year-old female with recurrent hematochezia. (A) Intraluminal contrast extravastion was noted in ileal loop (arrow). (B) Subsequent angiography revealed active contrast extravasation from ileal artery distal branch (arrow). (C) Successful arterial embolization was done (arrow).
Fig. 3.
Dynamic contrast-enhanced multidetector-row CT and capsule endoscopic image of a 73-year-old male with hematochezia. (A) Hyper-attenuating blood clot was visualized in ascending colon (asterisk). (B) Active ulcer (arrow) with fresh and old blood clot (arrowhead) was seen on the middle jejunum. Conservative management was performed and he did not experience recurrent bleeding after discontinuation of aspirin.
Fig. 4.
Dynamic contrast-enhanced multidetector-row CT (DCE-MDCT) and capsule endoscopic image of a 17-year-old male with recurrent iron deficiency anemia. (A) A small bowel hemangioma (arrow) with heterogeneous enhancement and small phleboliths were noted in the left side of pelvic cavity on DCE-MDCT. (B) A large pedunculated mass (arrows) with purplish surface was noted in the middle jejunum on capsule endoscopy. Surgical resection of the small bowel hemangioma was performed.
Fig. 5.
(A) Cumulative rebleeding rates of patients. (B) Cumulative rebleeding rates according to dynamic contrast-enhanced multidetector-row CT results.
Table 1.
Baseline Characteristics of the Patients (n=45)
Variable Data
Age (yr) 59.1±20.6
BMI (kg/m2) 23.4±3.6
Male 23 (51.1)
 Diabetes mellitus 7 (15.6)
 Hypertension 17 (37.8)
 Malignancy 8 (17.8)
 Ischemic heart disease 3 (6.7)
 Cerebrovascular disease 4 (8.9)
 Aspirin 10 (22.2)
 Clopidogrel 3 (6.7)
 Warfarin 1 (2.2)
 NSAIDs 7 (15.6)
Duration of symptom (day) 143.2±561.2
 Melena 20 (44.4)
 Hematochezia 15 (33.3)
 Iron deficiency anemia 10 (22.2)
OGIB subtype  
 Obscure OGIB 10 (22.2)
 Overt OGIB 35 (77.8)
Systolic blood pressure (mmHg) 127.1±22.5
Heart rate (beat/min) 89.1±18.6
Laboratory finding  
 Hemoglobin (g/dL) 8.4±2.6
 Platelet (103/μ L) 233.2±104.6
 Stool occult blood (+) 11 (24.4)
Diagnostic or treatment procedure  
 Capsule endoscopy 20 (44.4)
 Red blood cell scan 1 (2.2)
 Angiography 1 (2.2)
 Meckel's scan 3 (6.7)
 Operation 2 (4.4)
Transfusion of RBC for 24 hr (unit) 1.5±1.5
Massive bleeding 5 (11.1)
Treatment plan  
 Conservative management 39 (86.7)
 Specific treatment 6 (13.3)
 Endoscopic treatment 2 (4.4)
 Embolization 1 (2.2)
 Surgery 3 (6.7)
Follow-up duration (mo) 18.4±16.9

Values are presented as mean±SD or n (%).

OGIB, obscure gastrointestinal bleeding.

Table 2.
Clinical Characteristics of DCE-MDCT Positive Nine Patients
No. Age (yr) Sex Symptom CT finding Location Active bleeding on subsequent endoscopy Final diagnosis Treatment Follow-up duration (mo) Rebleeding
1 82 Female Melena Intraluminal contrast extravasation Descending colon None Colonic bleeding Observation (hold aspirin) 15 None
2 78 Female Melena Intraluminal contrast extravasation Jejunum None Small bowl ulcer bleeding Observation (hold warfarin) 12 Yes
3 25 Male Melena Intraluminal contrast extravasation Jejunum None Small bowel ulcer bleeding Observation (hold aspirin) 28 None
4 52 Female Hematochezia Intraluminal constrast extravasation Colon Yes Colonic diverticular bleeding Endoscopic hemostasis 3 None
5 61 Female Hematochezia Intraluminal contrast extravasation Ileum Not done Small bowel arterial bleeding Embolization 3 Yes
6 49 Male Hematochezia Intraluminal hematoma Ascending colon None Colonic diverticular bleeding Observation 23 Yes
7 73 Male Hematochezia Intraluminal hematoma Jejunum None Small bowel ulcer bleeding Observation (hold aspirin) 49 None
8 57 Male Hematochezia Mass lesion Ileum Not done Gastrointestinal stromal tumor bleeding Small bowel resection 0 None
9 17 Male IDA Mass lesion Jejunum None Small bowel hemangioma bleeding Surgery 41 None

DCE-MDCT, dynamic contrast-enhanced multidetector-row CT; IDA, iron deficiency anemia.

Table 3.
Comparison of Clinical Characteristics according to DCE-MDCT Results
Variable Positive (n=9) Negative (n=36) p-value
Age (yr) 54.9±22.4 60.2±20.3 0.497
 Aspirin 3 (33.3) 7 (19.4) 0.355
 Clopidogrel 0 (0) 3 (8.3) 1.000
 Warfarin 1 (11.1) 0 (0) 0.186
 NSAIDs 1 (11.1) 6 (16.7) 1.000
Duration of symptom (day) 407.2±1216.0 79.4±190.8 0.123
Overt OGIB 7 (77.8) 28 (77.8) 0.659
Systolic blood pressure (mmHg) 124.3±32.3 127.9±19.7 0.683
Heart rate (beat/min) 94.7±16.2 87.6±19.1 0.318
Laboratory finding      
 Hemoglobin (g/dL) 8.9±2.8 8.3±2.6 0.556
 Platelet (103/μL) 190.7±65.0 243.8±110.5 0.176
 Stool occult blood (+) 2 (50.0) 9 (34.6) 0.611
Diagnostic procedure      
 Capsule endoscopy 6 (66.7) 14 (38.9) 0.157
Transfusion of RBC for 24 hr (unit) 1.4±1.3 1.6±1.6 0.732
Massive bleeding 0 (0.0) 5 (13.9) 0.566
Treatment plan     0.010
 Conservative management 5 (55.6) 34 (94.4)  
 Specific treatment 4 (44.4) 2 (5.6)  
Active bleeding on endoscopy 1 (11.1) 2 (5.6) 0.497
Follow-up duration (mo) 21.8±16.9 18.1±17.0 0.586
Recurrent bleeding 3 (33.3) 4 (11.1) 0.106

Values are presented as mean±SD or n (%).

DCE-MDCT, dynamic contrast-enhanced multidetector-row CT; OGIB, obscure gastrointestinal bleeding; RBC, red blood cell.

Table 4.
Clinical Characteristics of Seven Patients with Recurrent Bleeding
No. Age (yr) Sex Symptom CT finding Final or possible diagnosis Initial treatment Time to recurrent bleeding (mo) Lesions of rebleeding Treatment after rebleeding
1 67 Female IDA Normal Small bowel ulcer bleeding Observation 4 Possible same lesion of 1st episode Observation
2 73 Male Melena Normal Possible small bowel bleeding Observation 5 Other lesion (peptic ulcer bleeding) Endoscopic hemostasis to peptic ulcer bleeding
3 77 Female Melena Normal Small bowel angiodysplasia bleeding Observation 3 Possible same lesion of 1st episode Endoscopic hemostasis to angiodysplasia bleeding
4 28 Female Hematochezia Normal Hemorrhoidal bleeding Observation 1 Possible same lesion of 1st episode Operation
5 78 Female Melena Intraluminal contrast extravasation Small bowl ulcer bleeding Observation (hold warfarin) 12 Possible same lesion of 1st episode Change from Warfarin to clopidogrel
6 61 Female Hematochezia Intraluminal contrast extravasation Small bowel arterial bleeding Embolization 0.3 Other lesion (ischemic colitis) Observation
7 49 Male Hematochezia Intraluminal hematoma Colonic diverticular bleeding Observation 22 Possible same lesion of 1st episode Endoscopic hemostasis to diverticular bleeding

IDA, iron deficiency anemia; OGIB, obscure gastrointestinal bleeding.

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