However, the use of single-photon emission CT (SPECT) and SPECT/CT have made the anatomical position of the uptake clear and contributed to the improved localization of the site of GIB [64]. Variant 5: Adult. Postsurgical or traumatic causes of nonvariceal upper gastrointestinal bleeding. Endoscopy is contraindicated. Initial imaging. This variant is applicable to postsurgical or trauma patients with UGIB, contraindicated to upper GI endoscopy. Arteriography Visceral VA is primarily reserved for unstable patients with UGIB and contraindicated for endoscopy, because it can be used for diagnosis and simultaneous treatment [27,65]. Typically, unstable patients with traumatic hemobilia and bleeding after mucosal or submucosal endoscopic mass resection may require VA [4,39,65]. In stable patients, VA may be performed after CTA, which can show the site of bleeding or a pseudoaneurysm [4,39]. CT Abdomen and Pelvis With IV Contrast There is no significant literature supporting the use of CT abdomen and pelvis with IV contrast for postsurgical or post-traumatic UGIB. However, in general, CT of the abdomen and pelvis with IV contrast is routinely used in trauma patients to assess for intra-abdominal injury. In a meta-analysis of 16 studies enrolling 12,514 patients, CT of the abdomen and pelvis had a sensitivity and specificity of 68% and 97%, respectively, for the diagnosis of traumatic hollow viscus injury [66]. (Note: CTA is a separate procedure distinct from CT abdomen and pelvis with IV contrast). CT Abdomen and Pelvis Without and With IV Contrast There is no significant literature supporting the use of CT abdomen and pelvis without and with IV contrast for postsurgical or post-traumatic UGIB. (Note: CTA is a separate procedure distinct from CT abdomen and pelvis without and with IV contrast). CT Abdomen and Pelvis Without IV Contrast There is no significant literature supporting the use of CT abdomen and pelvis without IV contrast for postsurgical or post-traumatic UGIB.
Nonvariceal Upper Gastrointestinal Bleeding. However, the use of single-photon emission CT (SPECT) and SPECT/CT have made the anatomical position of the uptake clear and contributed to the improved localization of the site of GIB [64]. Variant 5: Adult. Postsurgical or traumatic causes of nonvariceal upper gastrointestinal bleeding. Endoscopy is contraindicated. Initial imaging. This variant is applicable to postsurgical or trauma patients with UGIB, contraindicated to upper GI endoscopy. Arteriography Visceral VA is primarily reserved for unstable patients with UGIB and contraindicated for endoscopy, because it can be used for diagnosis and simultaneous treatment [27,65]. Typically, unstable patients with traumatic hemobilia and bleeding after mucosal or submucosal endoscopic mass resection may require VA [4,39,65]. In stable patients, VA may be performed after CTA, which can show the site of bleeding or a pseudoaneurysm [4,39]. CT Abdomen and Pelvis With IV Contrast There is no significant literature supporting the use of CT abdomen and pelvis with IV contrast for postsurgical or post-traumatic UGIB. However, in general, CT of the abdomen and pelvis with IV contrast is routinely used in trauma patients to assess for intra-abdominal injury. In a meta-analysis of 16 studies enrolling 12,514 patients, CT of the abdomen and pelvis had a sensitivity and specificity of 68% and 97%, respectively, for the diagnosis of traumatic hollow viscus injury [66]. (Note: CTA is a separate procedure distinct from CT abdomen and pelvis with IV contrast). CT Abdomen and Pelvis Without and With IV Contrast There is no significant literature supporting the use of CT abdomen and pelvis without and with IV contrast for postsurgical or post-traumatic UGIB. (Note: CTA is a separate procedure distinct from CT abdomen and pelvis without and with IV contrast). CT Abdomen and Pelvis Without IV Contrast There is no significant literature supporting the use of CT abdomen and pelvis without IV contrast for postsurgical or post-traumatic UGIB.