+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Urgent computed tomography for determining the optimal timing of colonoscopy in patients with acute lower gastrointestinal bleeding



Urgent computed tomography for determining the optimal timing of colonoscopy in patients with acute lower gastrointestinal bleeding



Internal Medicine 54(6): 553-558



We evaluated the diagnostic performance of computed tomography (CT) as an initial radiologic test for assessing the optimal timing of colonoscopy in patients with acute lower gastrointestinal bleeding (LGIB) and investigated the effectiveness of contrast-enhanced (CE) CT for detecting colonic diverticular bleeding. This was a retrospective study of 1,604 consecutive patients who visited or were referred to St. Marianna University Hospital due to acute LGIB and underwent colonoscopy within three months after presentation between September 2004 and December 2012. The clinicopathological data of the subjects were obtained from their medical records. Among the 1,604 patients presenting with LGIB, 879 (55%) underwent a CT scan. Elective colonoscopy was considered in cases in which typical colonic wall thickening was observed on CT, suggesting colonic inflammation or malignancy (239 patients; 27%). The diagnoses in the elective cases included ischemic colitis (38%), infectious colitis (8%), inflammatory bowel disease (8%) and malignancy (5%). Urgent colonoscopy was performed after the CT examination in 640 cases (73%). The most common presumptive CT diagnosis was diverticulum (402/640; 63%). Of the 638 patients who underwent CE-CT, diverticula were observed in 346 cases, including 104 cases of extravasation indicating ongoing diverticular bleeding. Among these 104 patients, the site of bleeding was identified in 71 subjects (68%) during colonoscopy. The rate of detection of the bleeding source on colonoscopy was significantly higher in the patients with extravasation on CE-CT than in those without extravasation on CE-CT (68% vs. 20%, respectively; p<0.001). Urgent CT is useful for determining the optimal timing of colonoscopy in cases of acute LGIB. CE-CT may be used to depict the presence and location of active hemorrhage and provides useful information for subsequent colonoscopy, especially in patients with diverticular bleeding.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 059209254

Download citation: RISBibTeXText

PMID: 25786443

DOI: 10.2169/internalmedicine.54.2829


Related references

Role of urgent contrast-enhanced multidetector computed tomography for acute lower gastrointestinal bleeding in patients undergoing early colonoscopy. Journal of Gastroenterology 50(12): 1162-1172, 2016

Value of urgent colonoscopy in diagnosis of severe acute lower gastrointestinal bleeding in patients with different bowel cleanliness. Nan Fang Yi Ke Da Xue Xue Bao 37(4): 522-527, 2017

The impact of timing of colonoscopy on length of hospital stay in patients with acute lower gastrointestinal bleeding. Gastroenterology 120(5 Suppl. 1): A 404, 2001

The utility of urgent colonoscopy in the evaluation of acute lower gastrointestinal tract bleeding: A 2-year experience from a single center. American Journal of Gastroenterology 96(6): 1782-1785, 2001

Colonoscopy in Acute Lower Gastrointestinal Bleeding: Diagnosis, Timing, and Bowel Preparation. Gastrointestinal Endoscopy Clinics of North America 28(3): 379-390, 2018

Adverse Events during Bowel Preparation and Colonoscopy in Patients with Acute Lower Gastrointestinal Bleeding Compared with Elective Non-Gastrointestinal Bleeding. Plos One 10(9): E0138000, 2016

Diagnostic Value of Computed Tomography in Crohn's Disease Patients Presenting with Acute Severe Lower Gastrointestinal Bleeding. Korean Journal of Radiology 19(6): 1089-1098, 2018

Role of enhanced multi-detector-row computed tomography before urgent endoscopy in acute upper gastrointestinal bleeding. Journal of Gastroenterology and Hepatology 29(4): 716-722, 2014

Optimal preprocedural imaging in acute lower gastrointestinal bleeding: computed tomographic angiography vs. nuclear medicine bleeding scan. Journal of Vascular and Interventional Radiology 28(2): S33-S34, 2017

Lower gastrointestinal bleeding: is urgent colonoscopy necessary for all hematochezia?. Clinical Endoscopy 46(5): 476-479, 2013

Analysis of Urgent Colonoscopy for Lower Gastrointestinal Tract Bleeding. Digestion 61(3): 189-192, 2000

Urgent colonoscopy in the diagnosis of lower gastrointestinal bleeding in children. Clinical Research 34(1): 119A, 1986

Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding. Digestion 61(3): 189-192, 2000

Timing of Colonoscopy and Outcomes Among Hospitalized Patients With Lower Gastrointestinal Bleeding -a Population Based Study. Gastrointestinal Endoscopy 77(5): Ab161-Ab162, 2013

Does Urgent Colonoscopy Improve Outcomes in the Management of Lower Gastrointestinal Bleeding?. American Journal of the Medical Sciences 353(3): 298-306, 2017