Skip to main content
SpringerLink
Log in

Prospective Evaluation of Contrast-Enhanced Computed Tomography for the Detection of Colonic Diverticular Bleeding

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

To prospectively evaluate the role of contrast-enhanced computed tomography (CE-CT) in the detection of colonic diverticular bleeding (CDB).

Patients and Methods

Consecutive patients who presented with hematochezia and were clinically suspected of CDB were prospectively enrolled. Those who could undergo both CE-CT and total colonoscopy, and who were finally diagnosed as CDB, were included in the analysis.

Results

Fifty-two cases were finally included in the analysis. The detection rate of CDB by CT was 15.4 % (8/52). Univariate analysis showed that the interval from the latest episode of hematochezia to the performance of CT and the presence of a past history of CDB were contributing factors for detection. The interval was 1.6 ± 4.6 h (mean ± SD) in patients detected by CT, and 3.4 ± 3.2 h in those without detection. The detection rate of CDB by total colonoscopy was 38.5 % (20/52). The overall detection rate was 46.2 % (24/52), which was superior to what CT or colonoscopy alone achieved.

Conclusions

CE-CT may play a complementary role to colonoscopy in patients with suspected CDB, but is not recommended for all cases due to its low detection rate. Patients who can be examined within 2 h of last hematochezia would be candidates for urgent CT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997;92:419–424.

    PubMed  CAS  Google Scholar 

  2. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004;363:631–639.

    Article  PubMed  Google Scholar 

  3. Reinus JF, Brandt LJ. Vascular ectasias and divertilulosis: common causes of lower intestinal bleeding. Gastroenterol Clin North Am. 1994;23:1–20.

    PubMed  CAS  Google Scholar 

  4. McGuire HH Jr, Haynes BW Jr. Massive hemorrhage for diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in fifty cases. Ann Surg. 1972;175:847–855.

    Article  PubMed  Google Scholar 

  5. Zuckerman GR, Prakash C. Acute lower intestinal bleeding: part II-etiology, therapy, and outcomes. Gastrointest Endosc. 1999;49:228–238.

    Article  PubMed  CAS  Google Scholar 

  6. Kang JY, Melville D, Maxwell JD. Epidemiology and management of diverticular disease of the colon. Drugs Aging. 2004;21:211–228.

    Article  PubMed  Google Scholar 

  7. Miura S, Kodaira S, Shatari T, Nishioka M, Hosoda Y, Hisa TK. Recent trends in diverticulosis of the right colon in Japan: retrospective review in a regional hospital. Dis Colon Rectum. 2000;43:1383–1389.

    Article  PubMed  CAS  Google Scholar 

  8. McGuire HH Jr. Bleeding colonic diverticula: a reappraisal of natural history and management. Ann Surg. 1994;220:653–656.

    Article  PubMed  Google Scholar 

  9. Potter GD, Sellin JH. Lower gastrointestinal bleeding. Gastroenterol Clin North Am. 1988;17:341–356.

    PubMed  CAS  Google Scholar 

  10. Loffroy R, Cercueil JP, Guiu B, Krause D. Detection and localization of acute lower gastrointestinal bleeding prior to therapeutic endovascular embolization: a challenge! Am J Gastroenterol. 2009;104:3108–3109.

    Article  PubMed  Google Scholar 

  11. Baum ST. Arteriographic diagnosis and treatment of gastrointestinal bleeding. In: Abram H, ed. Abram’s Angiography, vol. 3. Philadelphia: Lippincott, Williams & Wilkins; 1997:25.

    Google Scholar 

  12. Alavi A, Ring EJ. Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography. AJR. 1981;137:741–748.

    Article  PubMed  CAS  Google Scholar 

  13. Zink SI, Ohki SK, Stein B, et al. Noninvasive evaluation of active lower gastrointestinal bleeding: comparison between contrast-enhanced MDCT and 99mTc-labeled RBC scintigraphy. AJR. 2008;191:1107–1114.

    Article  PubMed  Google Scholar 

  14. Ettorre GC, Francioso G, Garribba AP, Fracella MR, Greco A, Farchi G. Helical CT angiography in gastrointestinal bleeding of obscure origin. AJR. 1997;168:727–731.

    Article  PubMed  CAS  Google Scholar 

  15. Ernst O, Bulois P, Saint-Drenant S, Leroy C, Paris JC, Sergent G. Helical CT in acute lower gastrointestinal bleeding. Eur Radiol. 2003;13:114–117.

    PubMed  Google Scholar 

  16. Yoon W, Jeong YY, Shin SS, et al. Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT. Radiology. 2006;239:160–167.

    Article  PubMed  Google Scholar 

  17. Scheffel H, Pfammatter T, Wildi S, Bauerfeind P, Marincek B, Alkadhi H. Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT. Eur Radiol. 2007;17:1555–1565.

    Article  PubMed  Google Scholar 

  18. Huprich JE, Fletcher JG, Alexander JA, Fielder JL, Burton SS, McCullough CH. Obscure gastrointestinal bleeding: evaluation with 64-section multiphase CT enterography-initial experience. Radiology. 2008;246:562–571.

    Article  PubMed  Google Scholar 

  19. Hara AK, Walker FB, Silva AC, Leighton JA. Preliminary estimate of triphasic CT enterography performance in hemodynamically stable patients with suspected gastrointestinal bleeding. AJR. 2009;193:1252–1260.

    Article  PubMed  Google Scholar 

  20. Kominami Y, Ohe H, Kobayashi S, et al. Dynamic computed tomography is useful for the diagnosis and colonoscopic treatment of colonic diverticular bleeding. Nihon Shokakibyo Gakkai Zasshi. 2011;108:223–230 (in Japanese with English abstract).

    PubMed  Google Scholar 

  21. Jensen DM, Machicado GA, Jutabha R, Kovacs TOG. Urgent colonoscopy for the diagnosis of severe diverticular hemorrhage. N Engl J Med. 2000;342:78–82.

    Article  PubMed  CAS  Google Scholar 

  22. Smoot RL, Gostout CJ, Rajan E, et al. Is early colonoscopy after admission for acute diverticular bleeding needed? AJR. 2003;98:1996–1999.

    Google Scholar 

  23. Bloomfeld RS, Rockey DC, Shetzline MA. Endoscopic therapy of acute diverticular hemorrhage. AJR. 2001;96:2367–2372.

    CAS  Google Scholar 

  24. Hokama A, Uehara T, Nakayoshi T, et al. Utility of endoscopic hemoclipping for colonic diverticular bleeding. AJR. 1997;92:543–546.

    CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, Miyagi, 983-0824, Japan

    Takashi Obana, Naotaka Fujita, Dai Hirasawa, Toshiki Sugawara, Yoshihiro Harada, Tetsuya Oohira, Yuki Maeda, Yoshiki Koike, Kenjiro Suzuki, Taku Yamagata, Jun Kusaka & Kaori Masu

  2. Department of Radiology, Sendai City Medical Center, Sendai, Japan

    Reiji Sugita

Authors
  1. Takashi Obana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naotaka Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Reiji Sugita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dai Hirasawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toshiki Sugawara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshihiro Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tetsuya Oohira
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuki Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yoshiki Koike
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kenjiro Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Taku Yamagata
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jun Kusaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kaori Masu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takashi Obana.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Obana, T., Fujita, N., Sugita, R. et al. Prospective Evaluation of Contrast-Enhanced Computed Tomography for the Detection of Colonic Diverticular Bleeding. Dig Dis Sci 58, 1985–1990 (2013). https://doi.org/10.1007/s10620-013-2629-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-013-2629-6

Keywords

Search

Navigation