DSA iSAP: Clinical Action Plan
Abdominal Angiography: Simulated Case Study of Gastrointestinal Bleeding
Clinical Concerns & Imaging Goals
A 50-year-old male patient present to Emergency Department with hematochezia. Patient’s CT demonstrated active bleeding in his rectum. Generally, gastrointestinal (GI) bleeding is caused by multitudes of pathologic processes, it has an intermittent nature and it could be a life-threatening condition for the patient (Cherian et al., 2009). Hence, it is crucial to determine the location of the haemorrhage and carry out appropriate measurement to stop bleeding as soon as possible.
Although abdominal angiography is an invasive procedure that associated with complications including contrast induced nephropathy, mesenteric ischemia and injuries to the arteries; it can locate the exact bleeding site by showing the leakage of contrast into lumen if the patient is active bleeding …show more content…
However, Kandarpa, Machan and Durham argued that more selective injection is required in order to properly visualise the extravasation of the contrast media into the GI lumen. In this situation, patient’s CT images revealed active bleeding in rectum, which is supplied by inferior mesenteric artery (IMA). Therefore, selective studies of IMA should be performed. The whole abdomen (where the IMA branches from abdominal aorta to the rectum) should be covered in order to make the angiographic images diagnostic …show more content…
Multiple images may be required to cover the entire bowel structure if it could not fit in one shot. Obliques may also be necessary to demonstrate IMA. According the patient’s presentation and his previous CT imaging, more detailed images can be taken for the distal IMA because it supplies the rectum section (Kandarpa, Machan and Durham,
Abdominal Angiography: Simulated Case Study of Gastrointestinal Bleeding
Clinical Concerns & Imaging Goals
A 50-year-old male patient present to Emergency Department with hematochezia. Patient’s CT demonstrated active bleeding in his rectum. Generally, gastrointestinal (GI) bleeding is caused by multitudes of pathologic processes, it has an intermittent nature and it could be a life-threatening condition for the patient (Cherian et al., 2009). Hence, it is crucial to determine the location of the haemorrhage and carry out appropriate measurement to stop bleeding as soon as possible.
Although abdominal angiography is an invasive procedure that associated with complications including contrast induced nephropathy, mesenteric ischemia and injuries to the arteries; it can locate the exact bleeding site by showing the leakage of contrast into lumen if the patient is active bleeding …show more content…
However, Kandarpa, Machan and Durham argued that more selective injection is required in order to properly visualise the extravasation of the contrast media into the GI lumen. In this situation, patient’s CT images revealed active bleeding in rectum, which is supplied by inferior mesenteric artery (IMA). Therefore, selective studies of IMA should be performed. The whole abdomen (where the IMA branches from abdominal aorta to the rectum) should be covered in order to make the angiographic images diagnostic …show more content…
Multiple images may be required to cover the entire bowel structure if it could not fit in one shot. Obliques may also be necessary to demonstrate IMA. According the patient’s presentation and his previous CT imaging, more detailed images can be taken for the distal IMA because it supplies the rectum section (Kandarpa, Machan and Durham,