Multidetector computed tomography three-dimensional and multiplanar reconstruction diagnosis of a rare cause of gastrointestinal bleeding: A case report

Figure 1 An esophagogastroduodenoscopy was performed to rule out esophageal and gastric variceal bleeding. A and B: Esophageal varices; C: Gastric varices; and D: No hemorrhage from the superficial ulcer (orange circle).

Figure 2 Abdominal computed tomography enhancement scan with intravenous iodixanol-320 administration. A and B: Scans, imaging and physical examination were normal on May 29, 2019; C and D: Enhancement, numerous enlarged branches of the blood vessels of the jejunum and tortuous irregular vessels (orange circle).

Figure 3 Multiplanar reconstruction showed a varicocele on the left side and venae testicularis as a tangled mass of vessels forming varicose veins, which anastomosed with the superior mesenteric vein (orange arrow). A: Axial plus coronal scanning; B: Sagittal scans; C: Images reconstructed with maximum intensity projection; and D: Images showing volume rendering three-dimensional reconstruction by spiral computed tomography.

Figure 4 Four-phase dynamic computed tomography features and identifying the bleeding in arterial-phase, portal-phase, equilibrium-phase, and delayed-phase scanning. A: The arterial-phase showed no abnormal signs of the blood vessel on computed tomography images; B: During the portal-phase, the testicular vein and the superior mesenteric vein gathered together with vascular dilatation, tortuosity, and active bleeding (orange circle); C: The equilibrium-phase also showed bleeding; and D: Delayed-phase scanning showed vascular mass enlargement.

Figure 5 Digital subtraction angiography indicating the bleeding points, which were then embolized to the feeding branches. A and C: Portal angiography, with bleeding points and contrast media extravasating into the intestinal tract; B: Digital subtraction angiography of the inferior vena cava; and D: No contrast agent extravasation after embolization therapy.

Figure 6 Hemoglobin level changes during hospitalization. After transfusion and embolization therapy, the patient’s hemoglobin level reached 78 g/L.