The term suspected small-bowel bleeding is used when the upper and lower GI tracts have been evaluated (typically with endoscopy) and no bleeding site has been identified ( 2, 3). In the current nomenclature, upper GI bleeding (UGIB) is defined as bleeding originating proximal to the Treitz ligament, and lower GI bleeding (LGIB) is defined as bleeding originating from the colon or rectum. Recent developments in the use of and techniques for performing CT angiography have made it a potential first-line tool for evaluating acute GI bleeding. In the emergent setting, CT may yield critical information regarding the presence, location, and cause of active bleeding-data that can guide the choice of subsequent therapy. CT angiography is used to examine stable and unstable patients who respond to resuscitation, are believed to be actively bleeding, and are considered unlikely to have an upper GI source of hemorrhage.
Multiphase CT enterography is used primarily to evaluate stable patients who have undergone upper and lower endoscopy without identification of a bleeding source.
Understanding the clinical evaluation of acute GI bleeding, including the advantages and limitations of endoscopic evaluation, is necessary for the appropriate selection of patients who may benefit from CT. The CT examinations used to evaluate acute GI bleeding include CT angiography and multiphase CT enterography. The use of computed tomography (CT) for evaluation of acute GI bleeding is gaining popularity because it can be used to rapidly diagnose active bleeding and nonbleeding bowel disease. The workup of GI bleeding is frequently prolonged and expensive, with examinations commonly needing to be repeated. The variety of enteric diseases that cause bleeding and the tendency for bleeding to be intermittent may make it difficult to render a diagnosis.
Bleeding can occur anywhere throughout the GI tract and may be caused by many types of disease. Acute gastrointestinal (GI) bleeding is common and necessitates rapid diagnosis and treatment.
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