Radiological imaging of gastrointestinal haemorrhage

Acute gastrointestinal haemorrhage (GIH) is a clinical emergency requiring a multidisciplinary approach and often involves emergency department physicians, acute general medicine physicians, geriatricians, gastroenterologists, surgeons, diagnostic radiologists and interventional radiologists. In the UK 2,500 patients die each year from internal bleeding. This accounts for 4% of acute admissions and has a mortality of 13-15%, largely because patients are often elderly with significant comorbidities. Seventy-five per cent of haemorrhages will stop spontaneously but a significant proportion, depending on the underlying aetiology, will re-bleed.

GIH is typically classified as upper or lower dependent on whether the site of haemorrhage lies proximal or distal to the ligament of Treitz. However, since the advent of deep or balloon-assisted enteroscopy a definition of mid-gut haemorrhage has been proposed as haemorrhage that occurs between the ligament of Treitz and the ileocaecal valve, with corresponding changes to the definitions of upper and lower GI haemorrhage. However, the original definition still persists, for now, in clinical practice.

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