Korean J Radiol.  2009 Aug;10(4):384-390. 10.3348/kjr.2009.10.4.384.

Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

• Kim JH
• Shin JH
• Yoon HK
• Chae EY
• Myung SJ
• Ko GY
• Gwon DI
• Sung KB

• KMID: 1777267
• DOI: http://doi.org/10.3348/kjr.2009.10.4.384

Abstract

OBJECTIVE
To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding.
MATERIALS AND METHODS
From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined.
RESULTS
The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 +/- 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding.
CONCLUSION
Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.

Keyword

Upper gastrointestinal bleeding; Lower gastrointestinal bleeding; Angiography

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
*Angiography
Arteries
Disseminated Intravascular Coagulation/etiology
Embolization, Therapeutic
Female
Gastrointestinal Hemorrhage/*radiography/surgery
Hemodynamics
Humans
Male
Middle Aged
Recurrence

Figure

• 

  Fig. 1 77-year-old man with lower gastrointestinal bleeding due to unknown cause. Initial angiography showed no bleeding focus.A. Following initial negative angiogram, rebleeding occurred. Degree of drop in hemoglobin level was 2.3 g/dL, however patient was hemodynamically stable. 99m Tc-red blood cell scintigraphy reveals active small bowel (jejunum) bleeding (arrows).B. Patient underwent second angiography. Arteriogram shows contrast extravasation from proximal jejunal branch of superior mesenteric artery.C. Final angiogram was performed after successful coil embolization.

• 

  Fig. 2 80-year-old man with lower gastrointestinal bleeding due to unknown cause. Initial angiography showed no bleeding focus. Arterial phase axial (A) and coronal (B) multidetector CT scans help identify extravasation (curved arrows) of contrast material into proximal jejunal lumen, indicating active bleeding.

• 

  Fig. 3 Flow diagram of study subjects.

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