A CASE REPORT OF SMALL INTESTINAL BLEEDING DIAGNOSED PREOPERATIVELY BY 320 – ROW MULTIDETECTOR COMPUTED TOMOGRAPHY PREOPERATIVELY

Abstract

We report a surgically treated case of small intestinal massive bleeding diagnosed by 320-row multidetector computed tomography (MDCT) preoperatively. An 85-year-old man came to our hospital and was admitted due to massive fresh melena. Endscopy for upper and lower digestive tract did not reveal an obvious bleeding origin. He had been hemodynamically unstable in spite of conservative therapy including blood transfusion. The second MDCT perfomed at the time of recurrent massive melena demonstrated ileal bleeding and the culprit artery clearly. At the emergent operation, active arterial bleeding was recognized in the ileum 70 cm proximal to the ileocecal valve, and partial resection of the ileum was performed. The pathological findings revealed a simple ulcer and angiodysplasia. Although 6 cases have been reported on the efficacy of MDCT in the diagnosis of small intestinal bleeding, this is the first report using 320-row MDCT. We suggest that kind of timely preoperative urgent imaging study will be a definite diagnostic modality for small intestinal bleeding.