When is emergency angiography indicated 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

Emergency angiography as an initial study is indicated in a highly selected group of patients with massive ongoing LGIB. Browder et al used two criteria to triage patients for emergency angiography: at least 4 units of blood transfusion in the first 2 hours following hospital admission and a systolic blood pressure lower than 100 mm Hg with aggressive resuscitation. [56] Fifty patients underwent emergency angiography, and bleeding was localized in 72% of patients. Vasopressin infusion was successful in 91%; however, 50% experienced rebleeding following cessation of the vasopressin infusion. [56] Thus, in patients with ongoing hemorrhage, emergency angiography, and vasopressin infusion have improved the operative morbidity, mortality, and outcome.

Widlus and Salis suggested that the use of reteplase, a fibrinolytic agent, is safe and effective as a provocative agent in angiography by stimulating bleeding to allow localization in patients with occult, recurrent, massive LGIB. [57] An initial diagnostic visceral arteriogram failed to identify the source of bleeding in each patient. When reteplase was administered and provocative arteriography was repeated, bleeding was identified in eight of nine (89%) patients, and these patients were treated with microembolization or segmental resection, or with conservative management. [57]


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