What is the role of angiography in the workup of lower gastrointestinal (GI) bleeding (LGIB)?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Answer

In 1965, Baum et al described selective mesenteric angiography in the diagnosis of gastrointestinal (GI) bleeding. [7] Since then, the value of mesenteric angiography in the diagnosis and management of lower GI bleeding (LGIB) has been well established.

Angiography is performed in the presence of active bleeding that precludes colonoscopy and after colonoscopy has failed to identify a bleeding site. Selective mesenteric angiography can detect bleeding at a rate of more than 0.5 mL/min.

In a patient with active GI bleeding, the radiologist first cannulates the superior mesenteric artery, because most of the hemodynamically significant bleeding originates in the right colon. The extravasation of contrast material indicates a positive study finding. If the findings from the study are negative, the inferior mesenteric artery is cannulated, followed by the celiac artery. In some cases, aberrant vascular anatomy can contribute to colonic or small bowel circulation; in other cases, patients with upper GI bleeding (UGIB) may present in an uncommon clinical fashion.


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