Excerpt
Acute lower GI bleeding is responsible for 1–2 % of hospital emergencies, 15 % of which manifest as massive, life-threatening bleeding. Initial clinical management focuses on identifying the site and cause of bleeding using scintigraphy, arteriography, and colonoscopy [
1‐
3]. Although optical colonoscopy is the procedure of choice, its use poses challenges in the emergency setting [
1]. Administration of bowel preparation, not always feasible in cases of massive bleeding, can delay the procedure for several hours; the presence of clots, blood, and stool in patients without preparation may hinder the visualization of the bleeding point, increasing the rate of incomplete studies when compared with nonemergent examinations. Furthermore, in 10–12 % of cases, the source of bleeding may be extracolonic [
4]. Angiography is an invasive procedure usually reserved for therapeutic purposes in patients with more severe, life-threatening bleeding. Technetium 99
m-labeled red blood cell scintigraphy is more sensitive than arteriography for identifying lower rate bleeding, although its emergency availability is variable, limiting its usefulness [
4]. Computed tomography (CT) and, more specifically, CT enterography is commonly used as a second-line procedure in nonemergent patients with unexplained GI bleeding after negative upper and lower endoscopy examinations [
5]. Since CT is rapid, noninvasive, and highly reproducible, it is commonly used in the acute setting for evaluating patients with lower GI bleeding emergencies, although optimal timing and patient characteristics for the diagnosis of colonic diverticular bleeding have not been established. In this issue, Obana et al. [
6] prospectively explored the utility of contrast-enhanced CT in 52 patients with colonic diverticular bleeding testing the hypothesis that CT complements colonoscopy in this setting. Favorable patient characteristics, based on univariate analysis, included feasibility of examination within 2 h of the last hematochezia, re-bleeding in hospital, or past history of diverticular bleeding. …
