James Ellis Jackson MD, Abstract Co-Author: Nothing to Disclose

Alex Mary Barnacle MD, Abstract Co-Author: Nothing to Disclose

Anthony Aylwin, Abstract Co-Author: Nothing to Disclose

Mary Roddie MD, Presenter: Nothing to Disclose

To review the final diagnosis and outcome in patients undergoing visceral angiography for gastrointestinal hemorrhage in whom a diagnosis of inflammatory bowel disease had been suspected on the basis of the angiographic findings.

Over a ten year period 522 visceral angiograms were undertaken for the investigation of gastrointestinal bleeding. Inflammatory bowel disease was reported as a possible or probable diagnosis based upon the angiographic findings in 44 (8.4%) patients (M:F = 24:20; age range 11-79; mean age 48.1 years). Several angiographic abnormalities were visualized the most common of which were increased vascularity of the bowel wall and early venous return. Other helpful signs included irregularity, abrupt truncation and/or angulation of the vasa recta within diseased segments of bowel and ‘skip’ involvement of small bowel loops.

Active IBD was confirmed in 25 individuals (57%; M:F = 15:10; mean age 46.5 years), representing 4.8% of all patients referred for the investigation of GI bleeding. A diagnosis of active Crohn’s disease was established in 21 of these 25 cases, active ulcerative colitis in two cases and non-specific colitis in two cases. The diagnosis was confirmed by histology in 18 cases (72%) and by characteristic changes on barium studies and appropriate response to subsequent medical therapy in the remainder. In fourteen of these individuals a diagnosis of IBD had not been suspected previously. The other 11 patients were known to have suffered from IBD but were thought to have quiescent disease at the time of presentation and were referred for visceral angiography with the explicit purpose of establishing a second diagnosis. A diagnosis other than IBD was found to be the cause of the angiographic findings in eight subjects. In the remaining eleven patients a cause for the angiographic abnormality was not established.

In a group of patients referred for angiography to investigate gastro-intestinal bleeding, IBD can be expected to be the cause in about 5% and may be diagnosed on the basis of angiographic findings even in those individuals without a pre-existing diagnosis.

Jackson, J, Barnacle, A, Aylwin, A, Roddie, M, The Angiographic Diagnosis of Inflammatory Bowel Disease in Patients Referred for the Investigation of Gastrointestinal Bleeding in Whom Other Investigations Have Been Negative.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4419010.html