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Angiographic Diagnosis of Inflammatory Bowel Disease in Patients Presenting with Gastrointestinal Bleeding

¹ Department of Imaging, Great Ormond St. Hospital for Children, London, United Kingdom.
² Department of Imaging, Hammersmith Hospital, Du Cane Rd., London W12 0HS, United Kingdom.

View larger version (139K): [in a new window]   Fig. 1A —38-year-old woman (patient 16 in Table 2) with chronic iron deficiency anemia. Superior mesenteric arteriogram shows several segments of proximal and distal ileum of increased vascularity (arrows).

View larger version (125K): [in a new window]   Fig. 1B —38-year-old woman (patient 16 in Table 2) with chronic iron deficiency anemia. Early venous phase image shows very prominent venous drainage from these segments of bowel.

View larger version (116K): [in a new window]   Fig. 1C —38-year-old woman (patient 16 in Table 2) with chronic iron deficiency anemia. Selective distal ileal arteriogram shows areas of diseased small bowel in more detail and reveals irregularity and truncation of vasa recta (arrows).

View larger version (125K): [in a new window]   Fig. 1D —38-year-old woman (patient 16 in Table 2) with chronic iron deficiency anemia. Venous phase image shows prominent intramural draining veins.

View larger version (128K): [in a new window]   Fig. 2A —69-year-old man (patient 8 in Table 1) with chronic iron deficiency anemia. Superior mesenteric arteriogram shows several short segments of ileal hypervascularity (arrows). Small vascular mesenteric lymph nodes (arrowheads) are also visualized.

View larger version (124K): [in a new window]   Fig. 2B —69-year-old man (patient 8 in Table 1) with chronic iron deficiency anemia. Prominent and early venous return is seen from segments of abnormal ileum.

View larger version (132K): [in a new window]   Fig. 2C —69-year-old man (patient 8 in Table 1) with chronic iron deficiency anemia. Selective ileal artery angiogram shows segment of ileal narrowing (arrows) consistent with presence of stricture. Note early venous return from this segment of small bowel.

View larger version (165K): [in a new window]   Fig. 3A —30-year-old man (patient 6 in Table 1) with history of chronic gastrointestinal bleeding and occasional acute episodes. Selective superior mesenteric artery angiogram shows subtle area of increased vascularity in proximal ileum (arrow).

View larger version (163K): [in a new window]   Fig. 3B —30-year-old man (patient 6 in Table 1) with history of chronic gastrointestinal bleeding and occasional acute episodes. Late arterial phase image shows more prominent segment of increased vascularity from which there is early venous return (arrow).

View larger version (127K): [in a new window]   Fig. 3C —30-year-old man (patient 6 in Table 1) with history of chronic gastrointestinal bleeding and occasional acute episodes. More selective studies show area of small-bowel abnormality in more detail together with some irregularity of vasa recta.

View larger version (143K): [in a new window]   Fig. 3D —30-year-old man (patient 6 in Table 1) with history of chronic gastrointestinal bleeding and occasional acute episodes. More selective studies show area of small-bowel abnormality in more detail together with some irregularity of vasa recta.

View larger version (140K): [in a new window]   Fig. 4A —36-year-old man (patient 2 in Table 1) with chronic iron deficiency anemia. Early (A) and late (B) arterial phase images from distal superior mesenteric artery angiogram show stretching and marked tortuosity of several distal ileal vasa recta (arrows, A). There is also increased vascularity of long segment of adjacent ileum (arrows, B), which is better seen on late arterial phase image (B).

View larger version (138K): [in a new window]   Fig. 4B —36-year-old man (patient 2 in Table 1) with chronic iron deficiency anemia. Early (A) and late (B) arterial phase images from distal superior mesenteric artery angiogram show stretching and marked tortuosity of several distal ileal vasa recta (arrows, A). There is also increased vascularity of long segment of adjacent ileum (arrows, B), which is better seen on late arterial phase image (B).

View larger version (133K): [in a new window]   Fig. 4C —36-year-old man (patient 2 in Table 1) with chronic iron deficiency anemia. Spot film from subsequent barium follow-through examination shows long segment of markedly abnormal distal ileum consisting of strictures, intervening dilatation, and bowel wall thickening.

View larger version (140K): [in a new window]   Fig. 5A —31-year-old man with long history of Hodgkin's lymphoma. Early (A) and late (B) arterial phase images from selective superior mesenteric artery angiogram show double-layer appearance of colonic bowel wall at hepatic flexure (arrows, A) with early venous return.

View larger version (137K): [in a new window]   Fig. 5B —31-year-old man with long history of Hodgkin's lymphoma. Early (A) and late (B) arterial phase images from selective superior mesenteric artery angiogram show double-layer appearance of colonic bowel wall at hepatic flexure (arrows, A) with early venous return.

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