New Approach for Acute Lower GI Bleeding -Using CT Scan as a Primary Tool for Diagnosis

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Purpose: For acute lower GI bleeding (ALGIB), colonoscopy is believed to be a valuable and important tool for diagnosis. However, especially in case of massive bleeding with circulatory insufficiency or with comobidity, colonoscopy is not always an effective tool given its characteristics that it is required relatively long time for completion and that its usefulness in treatment is limited. We set a new algorythm putting CT scan with “bleeding protocol” ahead of colonoscopy which is different from reported guidelines. Aim of this study is to evaluate our new algorythm of management of ALGIB featuring diagnostic CT scan with “bleeding protocol” ahead of colonoscopy. Methods: We reviewed a total of 203 consecutive patients with ALGIB presenting and admitted to our emergency department between 2003 and 2004. 30 patients (15%) were excluded for their presentation with hematemesis. Clinical features as (1) vital signs (2)characteristics of stool (3) past medical history (4)medication (5)CT scan findings are evaluated. Inclusion criteria for CT scanning was defined as the case satisfying one of the following: (1)systolic BP<80mmHg at any time (2)HR>systolic BP at any time (3) positive tilt test result. Outcome was recurrent bleeding requiring surgery or angiogram after admission. Results: Of 173 patients with ALGIB, 21(12%) were upper GI tract origin and excluded from further workup. Of 152(88%) of lower GI tract origin ALGIB, most cases are due to colon diverticuli. Of 173, CT scan was performed in 86 (50%), of which all of 50 (29%) with circulatory insufficiency were included. CT scan findings clarified location of ALGIB in almost all cases. 11 of 50 patients with circulatory insufficiency underwent angiogram. Of the 11 patients, nine had a finding of extravasation per CT scan. Recurrent bleeding after admission occured in two cases. Conclusions: Our approach to ALGIB ordering CT scan with “bleeding protocol” ahead of colonoscopy is effective and valuable from therapeutic standpoint especially for patients with vital unstability or comobidity. [figure 1]Figure