Gastrointestinal Bleeding Scintigraphy

Michael A. McDonald, MD, PhD; Harvey A. Ziessman, MD

Disclosures

Appl Radiol. 2016;45(5):19-22. 

In This Article

Introduction

Gastrointestinal bleeding (GIB) accounts for 20% of emergency room visits, 5% of ER admissions, and 2% of all hospital admissions.[1] An important initial step in the evaluation of GIB involves determining whether the source of the bleed is proximal or distal to the ligament of Treitz, located at the junction between the fourth segment of duodenum and proximal jejunum.[2] This defines the disease as upper or lower GIB, respectively. Upper GIBs, initially evaluated by nasogastric tube placement and esophagogastroduodenoscopy, are more common than lower GIBs, and have a mortality rate that is 2–3 times higher compared with LGI sources.[1]

Lower GIBs account for approximately 20% of all cases of acute GI hemorrhage, with an annual incidence of 20 per 100,000 people. Lower GIBs have a mortality rate of approximately 4%.[3] While 85% of Lower GIBs stop spontaneously, it is important to identify and stratify the remaining 15% according to those patients who are at higher risk and who are likely to benefit most from timely intervention.[4]

Diverticular disease accounts for 17–40% of the cases of lower GIBs, and results from weakness at the site in the colon wall where the circular muscle layer is penetrated by the vas recta which drape over the dome of the diverticulum and become susceptible to trauma and disruption.[5] A further 10–40% of lower GIBs are caused by angiodysplasia primarily of the cecum and right colon.[3] The most common causes of lower GIBs are listed in Table 1 .[2]

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