Use of arteriography in the diagnosis of occult gastrointestinal and traumatic intra-abdominal hemorrhage

Abstract

Selective visceral arteriography has proved to be a reliable diagnostic adjunct in evaluating selected cases of gastrointestinal hemorrhage or blunt abdominal trauma. Its use is advocated in gastrointestinal hemorrhage which cannot be localized by conventional diagnostic methods. Experimental work suggests that active bleeding at the rate of at least 0.6 ml. per minute may be identified by the appearance of intraluminal contrast medium during late phases of the arteriogram. Such observations were made clinically in two patients. In the absence of active bleeding other arteriographic features characteristic of aneurysm or tumor may demonstrate the responsible lesion. After blunt abdominal trauma, arteriography has proved useful in evaluating the presence or absence of intraabdominal visceral injury in five patients. Hepatic laceration and hematoma, thrombosis of the renal artery, and two cases of splenic tear were demonstrated by arteriography in four patients. The clinical evidence against the need for operative intervention was substantiated by a visceral arteriogram revealing no abnormalities in an eighth patient.