The intestinal tract.

Abstract

In this chapter, we have considered angiographic applications for diagnosis and management of patients with gastrointestinal bleeding and intestinal ischaemia. For patients with upper gastrointestinal bleeding, diagnostic angiography should be performed only when and if endoscopy is not available or non-contributory. For therapeutic purposes, angiography is applied in patients who continue to bleed despite conservative measures and intervention becomes unavoidable. Therapeutic interventions include the intra-arterial infusion of vasopressin and/or transcatheter embolization. In patients with rectal bleeding the addition of radionuclide studies has reduced the number of negative arteriographic examinations. We currently use the radionuclide studies only as a guide to whether active bleeding is present or not. If the radionuclide test is negative, we do not perform angiography. If it is positive we proceed with angiography in order to confirm localization and control bleeding with an intervention. For patients with rapid bleeding who are haemodynamically unstable we bypass nuclear medicine and proceed directly with angiography. In patients with suspected intestinal ischaemia, angiography is the only means of deciding whether ischaemia is of the occlusive or the non-occlusive form. Mesenteric vascular occlusions are treated surgically while low flow states are managed with mesenteric artery infusions of papaverine. Angioplasty has been and can be applied in patients with mesenteric arterial stenoses and symptoms of chronic intestinal ischaemia.