Active lower gastrointestinal bleeding - diverticular

Case contributed by Dr Michael P Hartung

Presentation

Bright red blood per rectum.

Patient Data

Age: 90
Gender: Male

Extensive diverticular disease of the colon. Active extravasation of contrast arising from a sigmoid diverticulum, with dispersement of contrast on portal venous phase images. 

Annotated images indicate the site of active extravasation, arising from a sigmoid diverticulum. 

Case Discussion

Very clear example of a positive GI bleeding study, with active extravasation of contrast from a sigmoid diverticulum. The dispersement/diffusion of contrast on delayed images is characteristic, and how this can be differentiated from artifact from dense stool. 

A comment/critique on the technique: Many GI bleeding protocols include a non-contrast phase, which can be helpful for excluding dense material in stool as a potential source of bleeding. However, this is probably not needed in most cases and increases the radiation dose. Also, oral contrast should not have been given, which could clearly obscure a small intestinal source of bleeding. Fortunately, only a small amount of contrast is in the cecum in this case. 

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Case information

rID: 61203
Published: 22nd Jun 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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